Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. Prompt and aggressive resuscitative strategies are crucial in promoting survivability. We present a case of AFE resulting in cardiopulmonary collapse and subsequent cardiac arrest where we were able to safely deliver the baby and resuscitate the mother with veno‐arterial extracorporeal membrane oxygenation and Impella CP—a novel combination known as ECPELLA. We discuss the implications of this approach as a more efficacious strategy in resuscitating AFE‐induced cardiogenic shock and arrest.

Background In patients with non-valvular atrial fibrillation, the vast majority of thrombi originate in the left atrial appendage (LAA). Thus, occluding the LAA significantly reduces one’s risk for developing an ischemic stroke. To date, many various surgical methodologies in LAA occlusion (LAAO)/exclusion have been studied and utilized. Unfortunately, patients are often left with incomplete closure of their LAA, leaving behind residual lobes that continue to allow thrombus formations. With the recent rise in percutaneous approaches and devices such as the WATCHMAN FLX, there has been proven success rates in achieving total closure of the LAA. Reports and investigations regarding the utilization of the WATCHMAN FLX devices in patients with surgically incomplete LAAO remains limited. Case Summary We present three cases of patients who had previously undergone surgical exclusion of the LAA yet unfortunately were left with residual LAA that continued to place them at high risk for an ischemic stroke. Percutaneous LAA occlusion with the WATCHMAN FLX was utilized to successfully achieve complete sealing of the residual lobes in failed LAA surgical closures. Discussion Our multicenter case series elucidates that an increased risk of stroke due to surgical LAAO failure is a real-world possibility that is likely to be encountered in clinical practice. We demonstrate in this series how the WATCHMAN FLX may provide a feasible and safe method to supplement a surgically incomplete LAAO to allow for improved ischemic stroke and systemic embolization risk reduction.

No abstract