# Low fetal age is not a contraindication for extracorporeal membranous oxygenation in COVID-19-related ARDS

Issaka Zalle, Yann Barthelemy, Antonio Piperata, Geraud Galvaing, Lionel Camilleri, Nicolas d'Ostrevy

► To cite this version:

Issaka Zalle, Yann Barthelemy, Antonio Piperata, Geraud Galvaing, Lionel Camilleri, et al. Low fetal age is not a contraindication for extracorporeal membranous oxygenation in COVID-19-related ARDS. Journal of Cardiac Surgery, 2022, 37 (4), pp.1059 - 1062. 10.1111/jocs.16251. hal-05488749

HAL Id: hal-05488749

https://uca.hal.science/hal-05488749v1

Submitted on 4 Feb 2026

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Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
Low Fetal Age Is Not a Contraindication for Extracorporeal Membranous Oxygenation in
COVID-19-Related ARDS

Issaka Zalle MD1 | Yann Barthelemy MD1 | Antonio Piperata MD2 |
Géraud Galvaing MD3 | Lionel Camilleri MD1 | Nicolas d'Ostrevy MD1,2

1 Cardiac Surgery, CHU Gabriel Montpied, Clermont-Ferrand, France

2 Cardiac Surgery, CHU Haut-Lévêque, Bordeaux, France

3 Centre Jean Perrin, Clermont-Ferrand, France

Correspondence:

Nicolas d'Ostrevy, MD

CHU Gabriel Montpied, 63000 Clermont-Ferrand, France

Email: ndostrevy@chu-clermontferrand.fr

ABSTRACT

Introduction:

The coronavirus disease 2019 (COVID-19) causes a small proportion of patients to be
admitted to intensive care units, where they sometimes require extracorporeal membrane
oxygenation (ECMO). The literature on pregnant women with COVID-19 who require ECMO
is sparse.

Case report:

We describe the earliest-fetal-age pregnant patient with COVID-19 who underwent ECMO and kept her child under close follow-up.

Conclusion:

The management of ARDS in pregnant women may benefit from ECMO even in early
pregnancy.

Keywords: perfusion
# 1 | INTRODUCTION

COVID-19 necessitates intensive care in a small proportion of patients. Infected individuals may require extracorporeal membrane oxygenation (ECMO), which carries an estimated mortality of 15%–50%.

Pregnancy complicates COVID-19 management, especially when pulmonary involvement requires ECMO. ARDS represents the most common indication.

Fewer than 10 cases of pregnant women with COVID-19 requiring ECMO have been reported. In most cases, pregnancy was advanced enough to allow cesarean section. We report the earliest fetal-age case, at 18 weeks' gestation.

# 2 | CASE REPORT

An 18-year-old woman, gravida II para 0, was admitted with COVID-19 at 18 weeks of pregnancy. Her previous pregnancy had been electively aborted.

Her current pregnancy was complicated by premature rupture of membranes. She was initially admitted with respiratory and digestive symptoms and tested positive for SARS-CoV-2. Oxygen therapy, dexamethasone, and enoxaparin were initiated. A low-dose CT scan demonstrated severe lung lesions involving 30% of the parenchyma. Four days later, mechanical ventilation was initiated. Due to instability, venovenous ECMO was started.

Cannulation was performed through the right femoral vein and right internal jugular vein under echocardiographic guidance.

At ECMO insertion, pCO2 was 53 mmHg and pO2 was 60 mmHg, with FiO2 at 100% and PaO2/FiO2 at 70 mmHg.

The patient was transferred for multidisciplinary follow-up. On admission, imaging revealed worsening lung lesions and left pulmonary embolism. Corticosteroid therapy and anticoagulation with unfractionated heparin were initiated. Prone positioning was used without fetal monitoring. Ultrasound follow-up showed normal fetal development.

ECMO weaning was achieved after 15 days. Mechanical ventilation was reduced and the patient was extubated. A tracheotomy was performed five days later. The patient was discharged with physiotherapy follow-up.

Pregnancy progressed normally. At 30 weeks, ultrasound and MRI confirmed normal fetal development with a weight of 1340 g.

# 3 | DISCUSSION

ARDS in COVID-19 appears more severe in pregnancy. Early delivery was not possible due
to fetal age. ECMO allows protective ventilation and maternal survival.

Neonatal survival after ECMO is around 65%. Hemorrhage is the main complication related to anticoagulation. Unfractionated heparin does not cross the placental barrier.

## 4 | CONCLUSION

The management of ARDS in pregnant women may benefit from ECMO.

Early pregnancy must not be considered a contraindication.

## CONFLICT OF INTERESTS

The authors declare no conflict of interests.

## AUTHOR CONTRIBUTIONS

Concept/design: Lionel Camilleri, Nicolas d'Ostrevy

Data analysis: Issaka Zalle, Yann Barthelemy, Nicolas d'Ostrevy

Drafting: Issaka Zalle, Yann Barthelemy, Antonio Piperata

Critical revision: Geraud Galvaing, Lionel Camilleri, Nicolas d'Ostrevy

Approval: All authors

## REFERENCES

1. Douglass KM et al. Am J Perinatol. 2021;38:82-87.

2. Naoum EE et al. J Am Heart Assoc. 2020;9:e016072.

3. Di Toro F et al. Clin Microbiol Infect. 2021;27:36-46.

4. Takayama W et al. Am J Case Rep. 2020;21:e927521.

5. Hou L et al. Heart Lung. 2021;50:33-36.

6. Tambawala ZY et al. BMJ Case Rep. 2021;14:e240823.

7. Tolcher MC et al. Obstet Gynecol. 2020;136:259-261.

8. Favre G et al. Lancet. 2020;395:e40.

9. Moore SA et al. J Thorac Cardiovasc Surg. 2016;151:1154-1160.

10. Sebastian NA et al. J Matern Fetal Neonatal Med. 2020.