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Amniotic fluid embolism rescued using venoarterial extracorporeal membrane oxygenation without initial anticoagulation: A case report and literature review.
- Source :
-
Medicine [Medicine (Baltimore)] 2024 May 17; Vol. 103 (20), pp. e38176. - Publication Year :
- 2024
-
Abstract
- 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.<br />Patients 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.<br />Diagnosis: Based on the course of the illness and imaging findings, the patient was diagnosed with AFE.<br />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.<br />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.<br />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.<br />Competing Interests: The authors have no funding and conflicts of interest to disclose.<br /> (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Subjects :
- Humans
Female
Adult
Pregnancy
Cesarean Section adverse effects
Blood Transfusion methods
Tranexamic Acid therapeutic use
Tranexamic Acid administration & dosage
Disseminated Intravascular Coagulation etiology
Disseminated Intravascular Coagulation therapy
Anticoagulants therapeutic use
Anticoagulants adverse effects
Anticoagulants administration & dosage
Embolism, Amniotic Fluid therapy
Embolism, Amniotic Fluid diagnosis
Extracorporeal Membrane Oxygenation methods
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 103
- Issue :
- 20
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 38758915
- Full Text :
- https://doi.org/10.1097/MD.0000000000038176