45: Effective Management of Severe Acute Respiratory Distress Syndrome Due to Eclampsia and Bronchial Asthma Using Extracorporeal Membrane Oxygenation at 26 Weeks of Gestation

Background: Eclampsia presents significant risks during pregnancy, characterized by seizures that threaten maternal and fetal health. Pre-existing conditions like eclampsia and bronchial asthma complicates management. In acute respiratory failure, extracorporeal membrane oxygenation (ECMO) is vital, providing essential support and stabilizing severely ill pregnant patients, ultimately improving outcomes for mothers and infants. Case Presentation: A 25-year-old woman with bronchial asthma and eclampsia, who had two prior abortions, was admitted to a tertiary care facility in January 2024 at 26 weeks of pregnancy. She presented with visual disturbances, headaches, left calf pain, fits, and decreased consciousness. Diagnosed with Eclampsia, Type II Respiratory Failure and Acute Respiratory Distress Syndrome (ARDS), she suffered another seizure upon ER arrival, leading to intubation and initiation of labetalol and magnesium sulfate infusions. Patient developed severe respiratory and lactic acidosis, necessitating high mechanical ventilation settings (FiO2 at 100%). ARDS protocol and Brain protective strategy were implemented. An emergency lower segment caesarean section (LSCS) was performed, resulting in the delivery of a live baby boy. Chest X-ray revealed left lung collapse, and worsened condition, requiring ECMO support through Venovenous access. ECMO treatment protocols were followed, and extubated on day 4. By day 5, she could sit up in bed while still on ECMO. Decannulation was done thereafter without complications; she was alert and stable, beginning on liquid diet with supplemental oxygen at 2lpm. After 8 days in ICU, she was transferred to the maternity ward and discharged 15 days later, while her baby remained in NICU. Conclusions: Managing pregnant patients with eclampsia and bronchial asthma requiring ECMO is complex but essential for maternal and fetal safety. Timely intervention and multidisciplinary care are vital. The successful use of ECMO stabilized the mother and improved outcomes for the newborn, emphasizing the need for advanced therapies in high-risk obstetrics.