Extracorporeal Cardiopulmonary Resuscitation for Amniotic Fluid Embolism: Review and Case Report.

Amniotic fluid embolism (AFE) is a rare, sudden, and catastrophic complication of pregnancy that can result in cardiopulmonary arrest, potentially leading to death. The pathophysiology of an AFE includes an inflammatory and coagulopathic response due to fetal materials entering maternal circulation with the hallmark triad of symptoms: acute respiratory distress, cardiovascular collapse, and coagulopathy. Management of AFE should include high-quality cardiopulmonary resuscitation, immediate delivery of the fetus if applicable, early intubation to provide adequate oxygenation and ventilation, fluid volume resuscitation, and ongoing evaluation of coagulopathy. Priorities include thromoboelastography interpretation if available, control of hemorrhage and coagulopathy with blood component therapy, and cardiovascular support through inotropes and vasopressor administration. More recent approaches include implementing the A-OK (atropine, ondansetron, and ketorolac) protocol for suspected AFE protocol, extracorporeal cardiopulmonary resuscitation (ECPR), and extracorporeal membrane oxygenation (ECMO) therapies to increase survival and decrease complications. Venoarterial ECMO is the highest form of life support that provides support in patients with pulmonary and cardiac failure. ECPR is the application of Venoarterial ECMO during cardiopulmonary resuscitation in cases where the cause of arrest is believed to be reversible. Early implementation of ECPR during the acute phase of AFE can provide support for end-organ perfusion in place of the weakened and recovering heart while optimizing oxygenation, making venoarterial ECMO an ideal adjunctive therapy. Because of the rarity of AFE, many obstetrical teams may have limited prior experience in managing these catastrophic cases; however, with ongoing education and simulation, teams can be better prepared in the recognition and management of these life-threatening events. During a cesarean birth, a woman experienced an amniotic fluid embolism. Through the work of a multidisciplinary team, and after numerous medications, blood products, and other treatments including extracorporeal cardiopulmonary resuscitation, she survived. A few weeks prior to this event, the multidisciplinary team in this maternity unit simulated an extracorporeal cardiopulmonary resuscitation maternal code scenario in the operating room. Several needs were identified and addressed prior to this case which contributed to the positive outcome. Multidisciplinary simulation on amniotic fluid embolism can help identify potential barriers and improve team knowledge and response. Details of the event and recommendations for other perinatal health care teams are provided. [ABSTRACT FROM AUTHOR]