Life-Threatening Amniotic Fluid Emboli Requiring Massive Blood Transfusion and Veno-Arterial Extracorporeal Membrane Oxygenation Therapy: Case Report and Review of the Literature

Abstract

Background: Amniotic fluid embolism (AFE) is a rare and disastrous condition that occurs during labor or soon after delivery. Its course is abrupt and rapidly progressive and may result in cardiorespiratory collapse, profound hemorrhage and multi organ failure. Mortality and morbidity are high, with many survivors suffering major neurologic sequelae. Disseminated intravascular coagulation (DIC), severe coagulopathy and hemorrhage may pose a risk for extracorporeal membrane oxygenation (ECMO) therapy due to the need of full anticoagulation treatment. Case Report: A 41 year old healthy parturient who developed fulminant AFE during cesarean delivery, accompanied by cardiac arrest, severe acute respiratory distress syndrome and DIC with profound obstetric hemorrhage. She was placed on veno-arterial ECMO as a rescue therapy and required more than 850 blood products. She had concomitant septic shock with E-coli bacteremia due to chroioamnionitis. Despite prolonged and complicated ICU course, including recurrent hemorrhage, multiple surgeries and sepsis, she survived to hospital discharge without neurologic sequelae. Conclusion: ECMO therapy may be considered as a rescue therapy in AFE cases, refractory to standard cardiorespiratory support, despite the increased risk for hemorrhage under full anticoagulation therapy. Interdisciplinary coordination is mandatory for a good outcome.