Improvement of Severe Maternal Covid-19 Outcome with the Use of EMCO (Extracorporeal Membrane Oxygenation) at Dr. Soetomo General Hospital Surabaya: Serial Case Study

Abstract

Indonesia, like many other nations, has been significantly impacted by the COVID-19 disease since its emergence in late 2019. The first COVID-19 case in Indonesia was reported in March 2020, affecting people of all ages, races, and backgrounds, including pregnant patients. Pregnancy has been recognized as a co-morbidity for COVID-19 by the CDC. Among the various issues observed in COVID-19 patients, respiratory complications have been prevalent, leading to the widespread use of oxygen support and respiratory assistance devices. Patients with severe respiratory problems due to COVID-19 often require ventilators, and in cases requiring longterm ventilator support, ECMO (extracorporeal membrane oxygenation) is employed. This serial case report presents three cases of severe maternal COVID-19 that necessitated treatment with both ventilators and ECMO. In the first case, the patient was diagnosed with severe COVID-19 at 35/36 weeks of gestation. The second case involved a patient diagnosed with mild COVID-19 at 30/31 weeks of gestation. The last case featured a patient with moderate COVID-19 at 35/36 weeks of gestation. All three patients received ECMO after the termination of their pregnancies. The maternal outcomes varied among the cases, with the third case reporting a poor outcome due to the severe complications such as pulmonary hypertension and septic shock. However, the other two patients experienced manageable complications and had favorable maternal outcomes. Given the severity of the disease, gestational age, and associated complications, the impact of COVID-19 on pregnancy is still a subject of ongoing investigation. Appropriate management strategies should be pursued to improve outcomes for both mother and fetus.