Management of Postpartum Cardiorespiratory Failure in a Patient with Sickle Cell Trait Requiring Ecmo Support and Airflight Transportation

Acute cardiovascular disorders are incriminated in up to 33% of maternal death and the presence of sickle cell anaemia (SCA) aggravates the risk of peripartum complications. Herein, we present a 24-year Caribbean old woman with known SCA who developed vaso-occlusive crisis at 36-week gestation that justified emergency caesarean section in Pointe à Pitre (Guadeloupe). In the early postpartum period, she experienced acute res-piratory distress in the context of COVID-19 infection that required tracheal intubation with mechanical ventilation. Cardiogenic shock with severe biventricular dysfunction developed that was initially treated with inotropes and vasopressors. As the hemody-namic condition worsened, the cardiac surgical and intensive care team at the Universi-ty Hospital of Martinique (UHM) was requested to apply veno-arterial extracorporeal membrane oxygenation (ECMO) support and, a few hours later, the patient was trans-ferred by helicopter to the UHM. Administration of cardiovascular drugs was rapidly tapered off, there were no signs of ongoing hemolysis and progressive recovery of ven-tricular function allowed weaning of ECMO support, three days after implantation. The patient was extubated one day later, chest-X-Rays showing partial resolution of lung edema and she was transported back to Guadeloupe under medical treatment.