Venoarterial Extracorporeal Membrane Oxygenation and Ventricular Assistance With Impella CP in an Amniotic Fluid Embolism

Mariño, María del Mar Eiras; Muñiz, Manuel Taboada; Castro, P. Otero; Nazar, B. Adrio; López, Luciano Espino; Bermejo, Rosa Agra

doi:10.1016/j.rec.2018.08.011

Cited by 2 publications

(5 citation statements)

References 5 publications

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“…[ 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. Many case reports did not include details related to anticoagulation during ECMO, suggesting a possible lack of interest.…”

Section: Discussionmentioning

confidence: 74%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, 14 case reports (74%) described the need for massive transfusions (defined as transfusion of 10 ≥ units of red blood cells [ 52 ] or when it was stated that massive transfusion was performed), indicating that bleeding tendency due to AFE and anticoagulation associated with ECMO are critical issues. In fact, at least in 3 cases, [ 42 , 45 , 48 ] bleeding was reported to have occurred after anticoagulation initiation. The patients were weaned off ECMO in 3 days (2–4 days), and in-hospital survival was as high as 100%; however, publication bias is a serious concern.…”

Section: Discussionmentioning

confidence: 99%

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

Araki,

Sekino,

Hasegawa

et al. 2024

Medicine

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Rationale: Amniotic fluid embolism (AFE) is a fatal obstetric condition that often rapidly leads to severe respiratory and circulatory failure. It is complicated by obstetric disseminated intravascular coagulation (DIC) with bleeding tendency; therefore, the introduction of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is challenging. We report the case of a patient with AFE requiring massive blood transfusion, rescued using VA-ECMO without initial anticoagulation. Patient’s concerns: A 39-year-old pregnant patient was admitted with a complaint of abdominal pain. An emergency cesarean section was performed because a sudden decrease in fetal heart rate was detected in addition to DIC with hyperfibrinolysis. Intra- and post-operatively, the patient had a bleeding tendency and required massive blood transfusions. After surgery, the patient developed lethal respiratory and circulatory failure, and VA-ECMO was introduced. Diagnosis: Based on the course of the illness and imaging findings, the patient was diagnosed with AFE. Interventions: By controlling the bleeding tendency with a massive transfusion and tranexamic acid administration, using an antithrombotic ECMO circuit, and delaying the initiation of anticoagulation and anti-DIC medication until the bleeding tendency settled, the patient was managed safely on ECMO without complications. Outcomes: By day 5, both respiration and circulation were stable, and the patient was weaned off VA-ECMO. Mechanical ventilation was discontinued on day 6. Finally, she was discharged home without sequelae. Lessons: VA-ECMO may be effective to save the lives of patients who have AFE with lethal circulatory and respiratory failure. For safe management without bleeding complications, it is important to start VA-ECMO without initial anticoagulants and to administer anticoagulants and anti-DIC drugs after the bleeding tendency has resolved.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Araki,

Sekino,

Hasegawa

et al. 2024

Medicine

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“…Notably, use of the ECPella combination has been reported in the management of amniotic fluid embolism complicated by CS and cardiac arrest, leading to safe delivery and maternal recovery. [ 57 , 58 ]…”

Section: Pulmonary Embolism and Shockmentioning

confidence: 99%

“…56 Notably, use of the ECPella combination has been reported in the management of amniotic fluid embolism complicated by CS and cardiac arrest, leading to safe delivery and maternal recovery. 57,58 Data regarding the use of pVADs in peripartum PE are very scarce; however, the feasibility and efficacy of support with Impella RP (rightsided Impella) in PE-induced right ventricular failure is well established in the literature. [59][60][61][62][63][64] In this regard, more research would be needed to define the role of MCS and pVADs in peripartum PE.…”

Section: Pulmonary Embolism and Shockmentioning

confidence: 99%

Peripartum Cardiogenic Shock and Mechanical Circulatory Support

Botti,

Thirunavukarasu,

Ziviello

et al. 2023

Interv Cardiol

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Despite remarkable improvements in the past two decades, the annual cardiovascular mortality rate has remained higher for women than for men. Pregnant women represent an underinvestigated population in clinical research, and the mechanisms of long-term cardiovascular complications in women with obstetric complications remain to be elucidated. Regarding advanced heart failure during pregnancy, interventional approaches are effective but still underutilised. Percutaneous mechanical circulatory support is a valuable option for peripartum cardiogenic shock, although its use during pregnancy is still limited. Survival rates have improved in recent years, but further emphasis on the importance of early recognition and initiation of heart failure treatment in this patient group is warranted. The aims of this review are to summarise the current literature on the implementation of mechanical circulatory support in cardiogenic shock during pregnancy and delivery and to understand the role of percutaneous ventricular assist devices in the management of such conditions.

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Venoarterial Extracorporeal Membrane Oxygenation and Ventricular Assistance With Impella CP in an Amniotic Fluid Embolism

Cited by 2 publications

References 5 publications

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

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

Peripartum Cardiogenic Shock and Mechanical Circulatory Support

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