The first case of Cesarean section in a pregnant woman during extracorporeal membrane oxygenation (ECMO) in Russia

A.A. Skopets1,2, A.S. Zharov1, S.I. Potapov1, E.S. Afonin1, M.D. Andreeva2, T.V. Galdina1, L.V. Shulzhenko1,2, E.V. Bezukh1, V.A. Porhanov1,2

1 State Public Health Budget Institution Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry, Krasnodar, Russia

2 State Budgetary educational institution of higher professional education Kuban State Medical University of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia

For correspondence: Alexander A. Skopets — M. D., Head of Department of Anesthesia and intensive care #2 Scientific Research Institute — Ochapovsky Regional Clinic Hospital, associate professor of the Department of Anesthesiology, Reanimatology and Transfusiology of the Kuban State Medical University, Krasnodar; e-mail: alskop1961@mail.ru

For citation: Skopets AA, Zharov AS, Potapov SI, Afonin ES, Andreeva MD, Galdina TV, Shulzhenko LV, Bezukh EV, Porhanov VA. The first case of Cesarean section in a pregnant woman during extracorporeal membrane oxygenation (ECMO) in Russia. Article. Annals of Critical Care. 2019;3:90–97.

DOI: 10.21320/1818-474X-2019-3-90-97


Abstract

A 22-year-old pregnant woman (34.6 weeks of pregnancy) with A(H1N1) influenza-associated acute respiratory distress syndrome was admitted to the intensive care unit. Results. The patient was connected to femoral-jugular veno-venous extracorporeal membrane oxygenation (ECMO) 2 hours after admission. On the 2nd day of ECMO support, in connection with the beginning of labor activity and a threat to the life of the mother and fetus, the decision was made on the implementation of caesarean section (CS) without the termination of ECMO. CS was performed under general anesthesia, 2 hours after discontinuation of heparin infusion. Were extracted a premature baby girl, weighing 2380 g. Intraoperative period was complicated by atonic uterine bleeding, requiring a hysterectomy. On the 16th day the patient was successfully weaned from ECMO and was discharged after 11 days. The newborn was discharged from the clinic in a satisfactory condition after 24 days with a weight of 2860 g. Conclusion. This is the first case in Russia of successful use of ECMO and emergency cesarean section (CS) during ECMO in a pregnant woman with acute respiratory distress syndrome (ARDS) due to complications of influenza A(H1N1).

Keywords: flu, pregnancy, extracorporeal membrane oxygenation, cesarean section.

Received: 14.08.2019

Accepted: 03.09.2019


References

  1. WHO Pandemic H1N1 — update 89 (online) <http:// www.who.int/csr/don/2010_02_26/en/index.html >; 2009 accessed 27.02.10.
  2. Louie J.K., Acosta M., Jamieson D.J., Honein M.A. Severe 2009 H1N1 influenza in pregnant and postpartum Women in California. NEJM. 2012; 362: 27–35.
  3. Patroniti N., Zangrillo A., Pappalardo F., et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011; 37: 1447–1457.
  4. Peek G.J., Mugford M., Tiruvoipati R., et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009; 374: 1351–1363.
  5. Sharma N.S., Wille K.M., Bellot S.C., Diaz-Guzman E. Modern use of extracorporeal life support in pregnancy and postpartum. ASAIO J. 2015; 61: 110–114.
  6. Jamieson D.J., Honein M.A., Rasmussen S.A., et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009; 374: 451–458.
  7. Creanga A.A., Johnson T.F., Graitcer S.B., et al. Severity of 2009 pandemic influenza A(N1N1) virus infection in pregnant women: New York City, May-June 2009. Obstet Gynecol. 2010; 115: 717–726.
  8. Fine A., Dentinger C., Johnson T.F., et al. 2009 pandemic influenza A(HH1N1) in pregnant women requiring intensive care — New York City, 2009. MMWR. 2010; 59: 321–326.
  9. Panarello G., D’Ancona G.D., Capitanio G., et al. Cesarean section during ECMO support. Minerva Anestesiol. 2011; 77(6): 654–657.
  10. Łysenko L., Zaleska-Dorobisz U., Blok R., et al. A successful cesarean section in a pregnant woman with A(H1N1) influenza requiring ECMO support. Kardiochir Torakochirurgia Pol. 2014; 11(2): 216–219.
  11. Parkins M.D., Fonseca K., Peets A.D., et al. A potentially preventable case of serious influenza infection in a pregnant patient. CMAJ. 2007; 177(8): 851–853.
  12. Kunstyr J., Lips M., Belohlavek J., et al. Spontaneous delivery during veno-venous extracorporeal membrane oxygenation in swine influenza-related acute respiratory failure. Acta Anaesthesiol Scand. 2010; 54(9): 1154–1155.
  13. Crawford T.C., Grimm J.C., Magruder J.T., et al. A curious case of acute respiratory distress syndrome. J. Surg. Case Rep. 2015; 2015(11).
  14. Liu C., Sun W., Wang C., Liu F., Zhou M. Delivery during extracorporeal membrane oxygenation (ECMO) support of pregnant woman with severe respiratory distress syndrome caused by influenza: a case report and review of the literature. J. Matern. Fetal. Neonatal. Med. 2019; 32(15): 2570–2574. DOI: 10.1080/14767058.2018.1439471
  15. Fine A., Dentinger C., Johnson T.F., et al. 2009 pandemic influenza A(HH1N1) in pregnant women requiring intensive care — New York City, 2009. MMWR. 2010; 59: 321–326.
  16. Nnaoma C., Chika-Nwosuh O.Z., Isedeh A., et al. Venovenous Extracorporeal Membrane Oxygenation in a Gravid Patient with Acute Respiratory Distress Syndrome: A Case Report. Am. J Case Rep. 2019; 20: 705–708. DOI: 10.12659/AJCR.914490
  17. Radsel P., Gorjup V., Jazbec A., et al. Pregnancy complicated by influenza A ARDS requiring consecutive VVECMO treatment with successful vaginal delivery. J Artif. Organs. 2018; 21(4): 471–474. DOI: 10.1007/s10047-018-1050-5
  18. Alyamani O., Mazzeffi M.A., Bharadwaj S., et al. Venovenous Extracorporeal Membrane Oxygenation to Prolong Pregnancy: A Case Report. AA Pract. 2018; 10(9): 229–231. DOI: 10.1213/XAA.0000000000000671
  19. Moore S.A., Dietl C.A., Coleman D.M. Extracorporeal life support during pregnancy. J. Thorac. Cardiovasc. Surg. 2016; 151(4): 1154–1160. DOI: 10.1016/j.jtcvs.2015.12.027
  20. Pacheco L.D., Saade G.R., Hankins G.D.V. Extracorporeal membrane oxygenation (ECMO) during pregnancy and postpartum. Semin. Perinatol. 2018; 42(1): 21–25. DOI: 10.1053/j.semperi.2017.11.005
  21. Anselmi A., Ruggieri V.G., Letheulle J. Extracorporeal Membrane Oxygenation in Pregnancy. J. Card. Surg. 2015; 30(10): 781–786. DOI: 10.1111/jocs.12605
  22. Itagaki T., Onodera M., Okuda N., et al. Successful use of extracorporeal membrane oxygenation in the reversal of cardiorespiratory failure induced by atonic uterine bleeding: a case report. J. Med. Case Rep. 2014; 8: 23. DOI: 10.1186/1752-1947-8-23
  23. Jo Y.Y., Park S., Choi Y.S. Extracorporeal membrane oxygenation in a patient with stress-induced cardiomyopathy after caesarean section. Anaesth. Intensive Care. 2011; 39: 954–957.
  24. Hansen A.J., Sorrell V.L., Cooper A.D., Moulton M.J. Postpartum rupture of the posteromedial papillary muscle. J. Card. Surg. 2012; 27: 313–316. DOI: 10.1111/j.1540-8191.2011.01369.x
  25. Pagel P.S., Lilly R.E., Nicolosi A.C. Use of ECMO to temporize circulatory instability during severe Brugada electrical storm. Ann. Thorac. Surg. 2009; 88: 982–983. DOI: 10.1016/j.athoracsur.2009.01.066
  26. Scherrer V., Lasgi C., Hariri S., et al. Radiofrequency ablation under extracorporeal membrane oxygenation for atrial tachycardia in postpartum. J. Card. Surg. 2012; 27: 647–649. DOI: 10.1111/j.1540-8191.2012.01487.x
  27. Shen H.P., Chang W.C., Yeh L.S., Ho M. Amniotic fluid embolism treated with emergency extracorporeal membrane oxygenation: A case report. J. Reprod Med. 2009; 54: 706–708.
  28. Strecker T., Мunch F, Weyand M. One hundred ten days of extracorporeal membrane oxygenation in a young woman with postpartum cerebral venous thrombosis and acute respiratory distress syndrome. Heart Surg. Forum. 2012; 15: E180–E181. DOI: 10.1532/HSF98.20111068
  29. Nair P., Davies A.R., Beca J., et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med. 2011; 37: 648–654. DOI: 10.1007/s00134-011-2138-z
  30. Sim S.S., Chou H.C., Chen J.W., Ma M.H. Extracorporeal membrane oxygenation in maternal arrhythmic cardiogenic shock. Am. J. Emerg. Med. 2012; 30: 1023.E3–1012.E5. DOI: 10.1016/j.ajem.2011.03.030
  31. Weinberg L., Kay C., Liskaser F., et al. Successful treatment of peripartum massive pulmonary embolism with extracorporeal membrane oxygenation and catheter-directed pulmonary thrombolytic therapy. Anaesth Intensive Care. 2011; 39: 486–491.
  32. Robertson L.C., Allen S.H., Konamme S.P., Chestnut J., Wilson P. The successful use of extra-corporeal membrane oxygenation in the management of a pregnant woman with severe H1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome. Int. J. Obstet. Anesth. 2010; 19: 443–447.
  33. Burrows K., Fox J., Biblo L.A., Roth J.A. Pregnancy and short-coupled torsades de pointes. Pacing. Clin. Electrophysiol. 2013; 36: e77–e79. DOI: 10.1111/j.1540-8159.2010.02923.x
  34. Корнелюк Р., Шукевич Д, Хаес Б. и др. Экстракорпоральная мембранная оксигенация и современные методы детоксикации в лечении вирусно-бактериальной пневмонии, обусловленной вирусом гриппа A(H1N1) у родильницы. Общая реаниматология. 2017;13(1): 45–56. DOI: 10.15360/1813-9779-2017-1-45-56. [Kornelyuk R.A., Shukevich D.L., Hayes B.L., et al. Extracorporeal Membrane Oxygenation and Modern Detoxification Techniques in a Puerpera with Viral and Bacterial Pneumonia Caused by Flu A(H1N1) Virus. General Reanimatology. 2017; 13(1): 45–56. (In Russ)]
  35. Кецкало М., Нечаев Д., Москаленко О. и др. Использование метода ЭКМО в комплексной терапии тяжелого ОРДС, осложнившегося развитием пневмоторакса. Клинические случаи. Медицинский алфавит. 2018; 18(335): 29–34. [Ketskalo M.V., Nechaev D.S., Moskalenko O.O., et al. Use of ECMO-method in complex therapy of severe ARDS, complicated by development of pneumothorax. Clinical cases. Medical alphabet. 2018; 18(335):29–34. (In Russ)]