Pregnant women with COVID-19 ARDS on the intensive care unit

• Published in: Die Anaesthesiologie 2024-06, Vol.73 (6), p.385
• Main Authors: Kalbhenn, J, Marx, O, Müller-Peltzer, K, Kunze, M, Bürkle, H, Bansbach, J
• Format: Article
• Language: ger
• Subjects: Adult; Cesarean Section; Cohort Studies; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - therapy; Critical Care - methods; Extracorporeal Membrane Oxygenation - methods; Female; Germany - epidemiology; Humans; Infant, Newborn; Intensive Care Units; Pregnancy; Pregnancy Complications, Infectious - therapy; Pregnancy Complications, Infectious - virology; Pregnancy Outcome - epidemiology; Respiratory Distress Syndrome - therapy; Respiratory Distress Syndrome - virology
• ISSN: 2731-6866; 2731-6866
• DOI: 10.1007/s00101-024-01405-5

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19 patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of a German university hospital between March and November 2021. The cohort included 9 patients with a mean age of 30.3 years (range 26-40 years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had a P O /F O index  0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, a total of 47 prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth. High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be co