Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic
BACKGROUND Septicemia in pregnancy may take an especially fulminant course. Adult respiratory distress syndrome (RDS) and disseminated intravascular coagulation (DIC) are associated life-threatening complications. Treatment consists of appropriate antibiotic coverage and supportive measures. CASE A previously healthy 21-year-old woman presented at 26 weeks' gestation with staphylococcal sepsis of undetermined origin. Her course was complicated by the rapid onset of adult RDS, DIC, and multi-organ-system failure, resulting in preterm delivery. Despite maximal ventilatory support, her pulmonary status continued to deteriorate. She was treated ultimately with extracorporeal carbon dioxide removal and survived without serious sequelae. CONCLUSION Extracorporeal carbon dioxide removal may improve survival in gravidas with adult RDS by decreasing the required airway pressures for ventilation, thus permitting pulmonary recovery.