Successful Extracorporeal Membrane Oxygenation in the Management of Acute Respiratory Distress Syndrome and Cardiopulmonary Collapse Secondary to Amniotic Fluid Embolism

Abstract

Listen

Translate article

Background Amniotic fluid embolism (AFE) is one of the most devastating complications of pregnancy that typically manifests as acute cardiopulmonary collapse during delivery or in the postpartum period. The potential role of extracorporeal membrane oxygenation (ECMO) as a management technique in severe cases of AFE remains largely unknown given the limited literature available. In this report, we present the first case, to our knowledge, of successful implementation of ECMO as a life-saving measure in a case of hemorrhagic shock due to postpartum bleeding complicated by severe AFE leading to acute respiratory distress syndrome (ARDS) ultimately requiring tracheostomy. Case report A 37-year-old G3P0020 female with with known anti-cardiolipin antibodies being managed with low molecular weight heparin and aspirin during pregnancy was admitted to the hospital for induction of labor in the 39th week of gestation. A Caesarian section was completed, which was complicated by severe post-partum hemorrhage requiring massive transfusion, tranexamic acid and uterine tamponade. On post-operative day two, she developed hypoxic respiratory failure requiring intubation. The patient suffered from persistent desaturation on maximal ventilator settings becoming increasingly cyanotic with profoundly hypotensive. In addition, she experienced recurrent bleeding that necessitated emergent hysterectomy. Chest X-ray showed findings suggestive of ARDS. AFE was suspected due to the sudden dire hypoxia and hypotension, and she was subsequently placed on Veno-Venous (VV) ECMO. She required multiple trips to the operating room during this interval for exploration and abdominal washout due to intra-abdominal bleeding. Eventually, bleeding was controlled and vital signs began to show improvement. After 10 days, the patient was decannulated and taken off ECMO support. After a challenging and undoubtedly complicated hospital course, she was successfully discharged home with minimal sequelae. Conclusions The timely incorporation of ECMO reversed an ill-fated hospital course of a patient with suspected AFE that was complicated by severe hemorrhagic shock and ARDS with persistent hypoxia despite maximized ventilator settings and paralysis. Hemodynamic decompensation is often rapid but transient in cases of severe AFE, and we recommend early consideration of ECMO implementation given its vital utility in these critical moments.