Case 33-2019: A 35-Year-Old Woman with Cardiopulmonary Arrest during Cesarean Section

Bernstein, Sarah N.; Cudemus-Deseda, Gaston; Ortiz, Vilma E.; Goodman, Annekathryn; Jassar, Arminder S.

doi:10.1056/nejmcpc1904046

Cited by 20 publications

(20 citation statements)

References 21 publications

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“…Subsequently, left ventricular failure with cardiogenic pulmonary edema and systemic hypotension may occur. 6 Simultaneously, factor VII, platelets, and clotting cascades are activated, causing the development of DIC. 7 Specific treatment for AFE does not exist, and the strategy for AFE is supportive.…”

Section: Discussionmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report

Adachi

Fujita

et al. 2021

J of Obstet and Gynaecol

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Amniotic fluid embolism (AFE) is a rare but fatal obstetric complication, characterized by sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation. Maternal mortality associated with AFE is high, making early recognition and prompt treatment important. In AFE with cardiac arrest, survival following acute cardiopulmonary dysfunction is crucial. In recent years, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has attracted attention as an aggressive treatment for AFE with cardiac arrest. A 40-year-old woman experienced sudden cardiac arrest due to AFE during cesarean section. Cardiopulmonary resuscitation and VA-ECMO (also called percutaneous cardiopulmonary support) were initiated early. Finally, she recovered without any complications. VA-ECMO can provide temporary respiratory and hemodynamic support until cardiopulmonary function improves after a few days in intensive care. VA-ECMO should be considered as an early treatment for AFE with cardiac arrest.

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Section: Discussionmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report

Adachi

Fujita

et al. 2021

J of Obstet and Gynaecol

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“…Amniotic fluid embolism is a catastrophic, often fatal complication of pregnancy, doubly worrisome for the obstetrician as advocate for both mother and baby. 1 In typical cases, a patient in labor suffers the sudden onset of hypotension (with systolic blood pressure <90 mmHg or cardiorespiratory arrest), and respiratory compromise (with dyspnea, cyanosis or oxygen saturation <90%), and disseminated intravascular coagulation. 2 What causes this syndrome?…”

Section: Discussionmentioning

confidence: 99%

“…Sudden cardiovascular collapse during labor and delivery can be due to pulmonary thromboembolism, hemorrhage, venous air embolism, anaphylaxis, high cephalad spread of epidural anesthesia, peripartum cardiomyopathy, eclampsia or amniotic fluid embolism. 1 Among these complications, amniotic fluid embolism remains one of the most feared because of its suddenness, severity and frequently fatal outcome. Emerging life-saving treatments for amniotic fluid embolism make it more promising to successfully treat this life-threatening cause of cardiovascular collapse during labor and delivery.…”

Section: Introductionmentioning

confidence: 99%

Amniotic fluid embolism: lessons for rapid recognition and intervention

Nichols¹,

Elmostafa²,

Nguyen³

et al. 2021

Autops Case Rep

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“…The most common causes for MCA are hemorrhage, heart failure, amniotic fluid embolism, sepsis, and complications due to spinal anesthesia (SPA) [3,4]. Fortunately, almost 59 % of patients who experience MCA survive to discharge [4][5] There are many published articles describing MCA, but we found none that would describe a rare case of an idiopathic asystole during caesarean section after delivery of a child [6].…”

Section: Introductionmentioning

confidence: 91%

“…From Becket et al, 16 of 59 pregnant women had cardiac arrest as a direct complication of obstetric anesthesia and of those women, 12 were obese [5]. According to Cook et al, the most likely etiology of MCA due to SPA is the blockade of sympathetic efferents, which are often a few levels higher than sensory efferents [15].…”

Section: Anesthetic Complicationsmentioning

confidence: 99%

Cardiac Arrest during Cesarean Section – A Case Report and Review of the Differential Diagnosis

Lukac

Mayer²,

Mühlen

et al. 2021

Z Geburtshilfe Neonatol

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Aim According to the World Health Organization, approximately 810 pregnant women die every day as a consequence of peripartum complications. A large proportion of deaths happen in developing countries. Peripartum cardiac arrest is a rare event that must be treated immediately. It is important to consider the differential diagnoses in order to save lives. Methods In this review, we discuss a differential diagnosis of cardiac arrest according to the BEAU-CHOPS scheme of the American Heart Association in the relation to the case report of our 40-year-old G5/P3 patient who went into cardiac arrest during cesarean delivery. Results Typical differentials for cardiac arrest during labor are bleeding, embolism, anesthetic complications, cardiovascular diseases, eclampsia, and sepsis. All of them were considered and ruled out in this patient. In the end, we suspect that physiological cardio-inhibitory reflexes triggered by sudden profound hypovolemia after placental separation along with the patientʼs risk factors, especially obesity and maternal age, and the administration of spinal anesthesia all potentially contributed to the cardiac arrest. Conclusions This review highlights that the cardiac arrest during labor can be triggered by the multifactorial etiology, but firstly the typical differential diagnosis needs to be excluded.

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Case 33-2019: A 35-Year-Old Woman with Cardiopulmonary Arrest during Cesarean Section

Cited by 20 publications

References 21 publications

Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report

Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report

Amniotic fluid embolism: lessons for rapid recognition and intervention

Cardiac Arrest during Cesarean Section – A Case Report and Review of the Differential Diagnosis

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