Cesarean section in patient with metastatic Ewing sarcoma requiring VA-ECMO support

Area of Science:

• Cardiology
• Oncology
• Obstetrics

Background:

• A pregnant patient with metastatic Ewing sarcoma presented with a growing sternal mass compressing the right ventricle outflow tract.
• Intubation posed significant risks due to the high-risk pregnancy and lack of cardiopulmonary support.

Observation:

• Computed tomography revealed extrinsic tumor compression of the right ventricle outflow tract.
• Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) was initiated in an awake patient prior to general anesthesia.

Findings:

• VA ECMO facilitated a safe Cesarean section (C-section).
• ECMO support was successfully withdrawn once stable ventilation and hemodynamics were achieved post-procedure.
• This represents a novel application of VA ECMO in obstetric surgery.

Implications:

• This case demonstrates the feasibility and life-saving potential of VA ECMO in complex obstetric scenarios involving critical maternal conditions.
• It highlights the importance of multidisciplinary collaboration in managing high-risk pregnancies with advanced malignancies.
• This approach may offer a viable solution for similar cases, improving maternal and fetal outcomes.