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

Abstract

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.

Amniotic fluid embolism rescued using venoarterial extracorporeal membrane oxygenation without initial anticoagulation: A case report and literature review

“…The case reports were extracted through a search of PubMed using the following search formula: "Embolism, Amniotic Fluid" (medical subject headings [MeSH]) AND "Extracorporeal Membrane Oxygenation" [MeSH]. As a result, 19 patients were identified from 19 case reports, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] including the case report cited in the extracted article. [43,46] Cases in which VA-ECMO was used only in the operating room or venovenous ECMO was used, were excluded.…”

“…At least 9 patients were anticoagulated within 12 hours of ECMO initiation (bolus administration and/or continuous administration), and heparin was the anticoagulant used in the majority of patients. Five patients were not anticoagulated within 12 hours of ECMO initiation, [ 39 , 40 , 47 , 48 ] whereas 3 patients who required ECMO for more than 4 days, including the patient in the present case, subsequently received anticoagulation. [ 40 , 48 ] The use of antithrombotic ECMO circuits was described in only 4 cases, 3 of which were heparin-coated circuits .…”

“…Five patients were not anticoagulated within 12 hours of ECMO initiation, [ 39 , 40 , 47 , 48 ] whereas 3 patients who required ECMO for more than 4 days, including the patient in the present case, subsequently received anticoagulation. [ 40 , 48 ] The use of antithrombotic ECMO circuits was described in only 4 cases, 3 of which were heparin-coated circuits . [ 39 , 40 , 42 ] Anti-DIC treatment was not mentioned in any of the cases, except for the present case.…”

Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation

“…Sudden onset of cardiovascular collapse, cardiac arrest, acute respiratory failure, and fulminant disseminated intravascular coagulopathy (DIC) during delivery are the main clinical signs of the most severe forms. Because the cardiopulmonary dysfunction associated with AFE is typically self-limited, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support has been reported in severe forms [ 3 , 4 ]. However, the rarity of the condition, and the difficulties to diagnose AFE, make it particularly challenging to study.…”

“…However, the rarity of the condition, and the difficulties to diagnose AFE, make it particularly challenging to study. To date, data available on this specific population rescued by VA-ECMO were mainly described in single-case reports [ 3 , 4 ] and concerns can be raised about the increased bleeding risks with ECMO in that context.…”