SCCM Resource Library-How to Save a Life: The Role of VA ECMO in a Young, Pregnant Woman with Newly Discovered Severe Pulmonary Hypertension

Pdf Summary

This document details the complex case of a 22-year-old pregnant woman with newly discovered severe pulmonary hypertension, which required the implementation of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as life support. The patient was at 39 weeks of pregnancy and presented with abdominal pain after her membranes ruptured. Subsequent imaging revealed severe right heart dilation indicative of significant pulmonary hypertension. <br /><br />Given her condition, a multidisciplinary team—including obstetrics, maternal-fetal medicine, pulmonary critical care, and anesthesiology specialists—opted for a trial of labor with epoprostenol therapy. During labor, fetal distress prompted an emergency C-section. Post-delivery, the patient's condition rapidly deteriorated, leading to hypoxia, hypotension, and eventually cardiac arrest. She was immediately cannulated for ECMO and transferred to the cardiac intensive care unit (CICU) for further management.<br /><br />In CICU, the patient required continuous renal replacement therapy (CRRT) for acidosis, multiple blood transfusions, and vasopressors. Despite aggressive treatment, her clinical condition necessitated a transfer to a transplant center.<br /><br />The case underscores significant considerations in utilizing VA ECMO versus VV ECMO, with VA ECMO being chosen due to the patient’s cardiac arrest. Complications and contraindications of ECMO are also discussed, including risks of thrombosis and hemorrhage, particularly due to the anticoagulation required by the ECMO circuit. <br /><br />The discussion further highlights pulmonary hypertension's risks in pregnancy, emphasizing that such conditions introduce high morbidity and mortality. This necessitates interdisciplinary communication and detailed role allocation to each team member, ensuring optimal patient care and timely decision-making.<br /><br />Ultimately, this case emphasizes the critical importance of advanced life support techniques like VA ECMO, coordinated multidisciplinary team efforts, and understanding of pathophysiological complexities to manage a high-risk obstetric patient effectively.

Asset Subtitle

Obstetrics, Pulmonary, Procedures, 2023, 0:10:00

Meta Tag

Content Type Critical Care Quick Study

Knowledge Area Obstetrics

Knowledge Area Pulmonary

Knowledge Area Procedures

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Obstetrics

Tag Pulmonary Hypertension

Tag Extracorporeal Membrane Oxygenation ECMO

Year 2023

Keywords

pulmonary hypertension

veno-arterial extracorporeal membrane oxygenation

VA ECMO

pregnancy

cardiac arrest

multidisciplinary team

epoprostenol therapy

emergency C-section

continuous renal replacement therapy

high-risk obstetric patient

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