Laurence Carlier1,4, Jan Muller2, Yves Debaveye2,4, Sandra Verelst4,5, Steffen Rex1,6

1Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
2Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium
3Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
4Department of Emergency Medicine, University Hospitals Leuven, Leuven, Belgium
5Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
6Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

Keywords: Pregnancy, Respiratory failure, Veno-venous extracorporeal membrane oxygenation, Prone ventilation


Introduction: Around 0.1–0.2% of all pregnancies are complicated by respiratory failure. The altered physiology of pregnancy predisposes mother and child to develop hypoxia and respiratory failure more easily than a non-pregnant patient. Respiratory failure in pregnancy may have detrimental fetal complications, therefore extensive knowledge of the range of therapeutic options is necessary. If conventional lung-protective mechanical ventilation strategies fail, alternative approaches such as veno-venous extracorporeal membrane oxygenation (VV-ECMO) should be considered.

Case presentation: A previously healthy 30-year-old P1G2 at 26 weeks and 6 days of gestation was admitted to the emergency department because of a severe respiratory infection. She suffered of severe hypoxic respiratory failure due to an overwhelming pneumonia (influenza type A) with acute respiratory distress syndrome (ARDS). Because long protective ventilation strategies and ventilation in prone positioning were inadequate, and further respiratory deterioration occurred, VV-ECMO was initiated.

Conclusion: In a pregnant patient with severe respiratory failure, when other interventions fail, initiation of VV-ECMO should not be delayed. The use of VV-ECMO in pregnancy is a multi-disciplinary team approach.