Korean J Crit Care Med.  2016 Aug;31(3):256-261. 10.4266/kjccm.2016.00213.

Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery

• Lee JH
• Jang HJ
• Park JH
• Kim YK
• Min HK
• Kim SY
• Kim HK

• KMID: 2350911
• DOI: http://doi.org/10.4266/kjccm.2016.00213

Abstract

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.

Keyword

amniotic fluid embolism; anaphylaxis; extracorporeal membrane oxygenation

MeSH Terms

Adult
Amniotic Fluid*
Anaphylaxis
Anoxia
Cardiopulmonary Bypass
Cesarean Section
Cognition
Embolism, Amniotic Fluid*
Extracorporeal Membrane Oxygenation*
Female
Humans
Peripartum Period
Pregnancy
Pregnant Women
Pulmonary Circulation
Shock

Figure

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  Fig. 1. Computed tomography (CT) scans from a 36-year-old female who survived acute respiratory distress syndrome. (a) CT pulmonary angiography with coronal maximum intensity projection reconstruction reveals no filling defect. (b) Axial CT scan with lung algorithm displays typical areas of intense parenchymal opacification in the dependent lung and nondependent ground-glass opacification.

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  Fig. 2. Echocardiograms (A, B) and schematic representation of the left ventricular (LV) echocardial borders (C) during diastole and systole. Transthoracic 4–chamber view at admission demonstrates apical and midventricular dilatation of the LV, accompanied by severe global hypokinesia.

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  Fig. 3. Pathology of a central venous blood sample reveals degenerative squamous epithelium (A: Hematoxylin and eosin stain, B: Papanicolaou stain).

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  Fig. 4. Chest radiograph from a 36-year-old female who survived acute respiratory distress syndrome. (A) Initial chest radiograph displays typical areas of diffuse consolidation in both lungs. The patient required extracorporeal membrane oxygenation (ECMO) due to uncorrected desaturation. (B) After 1 week, the ECMO catheter was removed. The chest radiograph displays the reduced extent of consolidation and improved aeration in both lungs.

Reference

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