Amniotic Fluid Embolism Treated with Veno-Arterial Extracorporeal Membrane Oxygenation

Gitman, Robert; Bachar, Bradlee J.; Mendenhall, Byron

doi:10.1155/2019/4589636

Cited by 10 publications

(16 citation statements)

References 12 publications

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“…In the application of ECMO in pregnant women/parturients, there are both obstetric and non-obstetric factors. In developed countries, ECMO technology has been increasingly reported in the treatment of pregnant women/parturients with acute respiratory failure, severe heart failure, postpartum hemorrhage induced cardiac arrest, pulmonary embolism, and amniotic fluid embolism [ 14 – 16 ]. Ong et al systematically reviewed ECMO indications of 97 pregnant women/parturients and found that adult respiratory distress syndrome (91.9%) was the most common respiratory tract indication, while pulmonary embolism (23.7%) and perinatal cardiomyopathy (16.9%) were the two most common cardiovascular indications [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Five critically ill pregnant women/parturients treated with extracorporeal membrane oxygenation

Liu

et al. 2022

J Cardiothorac Surg

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Background Maternal mortality has always been a major medical concern. Recently, the successful application of extracorporeal membrane oxygenation (ECMO) technology in the rescue of near-death patients has been reported. Case presentation This study retrospectively analyzed 5 cases of critically ill pregnant women/parturients treated with ECMO for respiratory and circulatory failure in the Wuxi People’s Hospital from 2018 to 2020. The mean age of the 5 cases was 30.2 years. Among them, Cases 1 and 5 were treated with Venoarterial (VA) ECMO. Case 1 was diagnosed with congenital heart disease, atrial septal defect, and severe pulmonary hypertension. VA ECMO was applied before cesarean section and was successfully removed after double lung transplantation, but the patient died 10 months after delivery from lung infection. While Case 5 was diagnosed with systemic lupus erythematosus, lupus nephritis, thrombotic vascular disease, HELLP syndrome, and cerebral hemorrhage. VA ECMO was applied 39 days after cesarean section, and the patient died 40 days after delivery due to multiple organ failure. Cases 3 and 4 were treated with Venovenous (VV) ECMO. Case 3 was diagnosed with refractory postpartum hemorrhage, and Case 4 was diagnosed with postpartum hypoglycemic coma, aspiration pneumonia, and shock. They were treated with VV ECMO after delivery, and all survived after successful evacuation. Another Case (Case 2) was diagnosed with postpartum pelvic infection, sepsis and septic shock, and was treated with VA ECMO at 15 days after delivery. The patient changed to VV ECMO at 30 days after delivery due to significant improvement in heart function and poor lung function, but eventually died of multiple organ failure. For the 5 cases, the mean duration of ECMO was 8.7 days, the mean duration of intensive care was 22.0 days, and the mean length of hospital stay was 57.6 days. As a result, 3 patients gradually returned to normal with significant improvement in ventilation and oxygenation after ECMO treatment. Conclusions ECMO technology can be used to treat some of the critical obstetric patients with respiratory and circulatory failure that is ineffective to conventional treatment, but it has no therapeutic effect on the primary disease.

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Section: Discussionmentioning

confidence: 99%

Five critically ill pregnant women/parturients treated with extracorporeal membrane oxygenation

Liu

et al. 2022

J Cardiothorac Surg

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“…As in our case, the patient was in severe hemodynamic compromise, DIC, requiring massive transfusion protocol and was refractory to vasopressor support going into cardiac arrest where early intervention with ECMO led to a successful outcome. Not only prompt intervention but also early weaning of ECMO is important, as complications like hemolysis, renal function impairment, intracranial hemorrhage, sepsis, and limb ischemia are directly related to the duration of the extracorporeal life support [ 14 - 15 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Extra Corporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Case Report and Literature Review

Durgam¹,

Sharma²,

Dadhwal³

et al. 2021

Cureus

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Amniotic fluid embolism (AFE) is a rare and life-threatening complication related to pregnancy. Early diagnosis and prompt intervention are important tools for the survival of the patient. Despite early intervention, mortality rate remains high. We present a case of a 19-year-old female who was admitted for labor induction and delivery. Her delivery course was complicated by meconium-stained amniotic fluid. The patient went into acute hypoxic respiratory failure (AHRF) and hemodynamic compromise within half an hour following delivery secondary to AFE. We hereby discuss the role of timely initiation of extra corporeal membrane oxygenation (ECMO) in a case of AFE which could have otherwise turned out to be fatal.

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“…In the recent literature, ECMO should be considered in cases requiring prolonged CPR or, after an arrest, severe ventricular dysfunction refractory to medical management. 1 Although early indication of VA-ECMO has been described in some reports, 12,13 evidence supporting the beneficial outcomes of VA-ECMO use is insufficient, making its use controversial and not routinely recommended for AFE.…”

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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Amniotic Fluid Embolism Treated with Veno-Arterial Extracorporeal Membrane Oxygenation

Cited by 10 publications

References 12 publications

Five critically ill pregnant women/parturients treated with extracorporeal membrane oxygenation

Five critically ill pregnant women/parturients treated with extracorporeal membrane oxygenation

The Role of Extra Corporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Case Report and Literature Review

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

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