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Extracorporeal membrane oxygenation as a bridge to cesarean delivery in preeclampsia with severe features: a case
Jaromir Vajter1, Kristina Kaluzova2, Lenka Laitnerova1
1Department of Anesthesiology, Resuscitation and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University and FNMH, Prague, Czech Republic; ECLS Center, Department of Anesthesiology, Resuscitation and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University and FNMH, Prague, Czech Republic.
Preeclampsia with severe features complicated by acute cardiopulmonary failure is rare and may require maternal stabilization before delivery. A 37-year-old woman at 36 weeks' gestation with gestational hypertension presented with sudden dyspnea, severe hypertension, profound hypoxemia, and rapid loss of consciousness. Echocardiography showed severe left ventricular dysfunction with an ejection fraction below 20%, with increasing vasopressor requirements despite intubation and mechanical ventilation. Because cesarean delivery before cardiopulmonary support was considered unsafe, venoarterial extracorporeal membrane oxygenation was initiated as a bridge to delivery without systemic anticoagulation. Cesarean delivery commenced concurrently with target extracorporeal membrane oxygenation flow. Maternal cardiac function recovered over 48 h; mechanical support was discontinued on day 3, and she left intensive care on day 9. The neonate required intubation and therapeutic hypothermia but was discharged home in good condition. This case supports individualized delivery timing and venoarterial extracorporeal membrane oxygenation as rescue support in selected critically unstable patients.
Preeclampsia with severe features complicated by acute cardiopulmonary failure is rare and may require maternal stabilization before delivery. A 37-year-old woman at 36 weeks' gestation with gestational hypertension presented with sudden dyspnea, severe hypertension, profound hypoxemia, and rapid loss of consciousness. Echocardiography showed severe left ventricular dysfunction with an ejection fraction below 20%, with increasing vasopressor requirements despite intubation and mechanical ventilation. Because cesarean delivery before cardiopulmonary support was considered unsafe, venoarterial extracorporeal membrane oxygenation was initiated as a bridge to delivery without systemic anticoagulation. Cesarean delivery commenced concurrently with target extracorporeal membrane oxygenation flow. Maternal cardiac function recovered over 48 h; mechanical support was discontinued on day 3, and she left intensive care on day 9. The neonate required intubation and therapeutic hypothermia but was discharged home in good condition. This case supports individualized delivery timing and venoarterial extracorporeal membrane oxygenation as rescue support in selected critically unstable patients.
