Successful ECMO-assisted open chest cardiopulmonary resuscitation in a postpartum patient with delayed amniotic fluid embolism

Yafen Wu,Shouping Wang,Hong Zhan,Jin Luo,Junxing Chen,Jinfa Liu,Tao Chen

doi:10.1186/s40001-021-00628-1

Abstract

BackgroundAmniotic fluid embolism (AFE) is a rare but potentially dangerous severe obstetrics complication, which is accompanied by an incidence between 1.9 and 6.1 per 100,000 births.Case presentationHere, we report an AFE case after cesarean delivery diagnosed on a cardiac arrest complicated by acute respiratory distress syndrome and coagulopathy. Diagnosis, risk factors and pathophysiology for AFE have been fully discussed, besides, extracorporeal membrane oxygenation in the early management of cardiac arrest was used, describing the indication, efficacy and successful performed of open-chest cardiopulmonary resuscitation for the patient.ConclusionIn AFE with cute cardiovascular collapse, extracorporeal membrane oxygenation support can be considered as the alternative therapies.

Highlights

Amniotic fluid embolism (AFE) is an obstetrical catastrophic syndrome, which occurs when amniotic fluid has entered maternal circulation causing respiratory failure, coagulation dysfunction and other pathological changes of obstetrical specific severe syndromes [1]
We report an AFE case with cardiac arrest successfully treated by extracorporeal membrane oxygenation (ECMO) and open chest cardiopulmonary resuscitation (OCCPR)
After continuous chest compressions and multiple electrical de-fibrillation, on many occasions, the patient can recovery to normal sinus arrhythmia, but few minutes later, ventricular fibrillation repeated occurred alternately. 144 min after delivery of the infant, cardiac arrest recurred again, the pulse decreased to 0 bpm, and oxygen saturation decreased to 60% accompanied by lowered blood pressure to 42/24 mmHg

Summary

Introduction

AFE is an obstetrical catastrophic syndrome, which occurs when amniotic fluid has entered maternal circulation causing respiratory failure, coagulation dysfunction and other pathological changes of obstetrical specific severe syndromes [1]. We report an AFE case with cardiac arrest successfully treated by extracorporeal membrane oxygenation (ECMO) and open chest cardiopulmonary resuscitation (OCCPR). 144 min after delivery of the infant, cardiac arrest recurred again, the pulse decreased to 0 bpm, and oxygen saturation decreased to 60% accompanied by lowered blood pressure to 42/24 mmHg. even under continuous chest compressions and multiple electrical de-fibrillation, the heart rhythm was difficult to recover, and the cardiopulmonary circulation was even worse. The maternal obesity, physiological anatomy changes in pregnancy with the diaphragm moved up and breast enlargement, resulting in worse and ineffective effect on cardiopulmonary resuscitation For those reasons, an open chest cardiac massage had to be performed on the patient. The patient was subsequently transferred out of the ICU to the medical center after the surgery 30 days, and she went back home without any cardiac complications and neurological sequelae after 90 days of hospitalization

Discussion

Findings

Conclusion