Venous-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) as a Bridge to Recovery in the Treatment of Amniotic Fluid Embolism (AFE)-Induced Cardiac Arrest
Presenter
Mostafa Naguib, M.D., Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ
Mostafa Naguib, M.D., Omar Safdar, MD, Raul Flores, MD, Abhishek Singh, MD, PhD, Dimitrios Karmpaliotis, M.D., FSCAI and Amirali Masoumi, M.D., Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ
Title:
Venous-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) as a Bridge to Recovery in the Treatment of Acute Amniotic Fluid Embolism (AFE)-Induced Circulatory Arrest Introduction:
Amniotic Fluid Embolism (AFE) is a rare, yet devastating complication of pregnancy with an incidence of 2.5 to 6.1 cases per 100,000 deliveries and a mortality rate up to 60%. AFE is characterized by rapidly progressing right ventricular failure, circulatory collapse leading to cardiac arrest, respiratory failure, and disseminated intravascular coagulation (DIC) - posing significant diagnostic and therapeutic challenges. Clinical Case:
A 33-year-old G2P1001 female, presents at full term for an elective cesarian-section. Shortly after delivery, the patient developed respiratory distress, cardiovascular collapse and DIC with hemorrhagic shock, which immediately deteriorated into recurrent PEA arrests, with ongoing ACLS. Transesophageal echocardiography performed during ACLS demonstrated severe right ventricular failure. Through a multidisciplinary cardiogenic shock team approach, the decision was made to proceed with extra corporeal cardiopulmonary resuscitation (ECPR) via emergent peripheral fem-fem venous-arterial extracorporeal oxygenation (VA-ECMO). After cannulation, ROSC was achieved with significant improvement in patient’s hemodynamic profile. The patient’s clinical condition continued to improve with notable recovery of biventricular function on echocardiography. She underwent decannulation on day 2. She was subsequently discharged in stable and good condition on day 11. Discussion:
The survivability of patients with AFE-induced cardiovascular collapse is dependent on prompt recognition and aggressive resuscitative strategies. Current algorithms for managing AFE-induced cardiovascular collapse focus on the implementation of ACLS and supportive measures, yet the associated mortality rate remains unacceptably high. The application of VA-ECMO in the setting of AFE-induced refractory cardiogenic shock or cardiac arrest, has emerged as a promising rescue intervention. We aim to contribute to the growing body of evidence supporting the selective use of ECPR in the complex care of AFE, while addressing the intricate balance between lifesaving intervention and the risk of exacerbating hemorrhagic complications. In conclusion, VA-ECMO holds significant potential in managing cases of severe cardiopulmonary failure, including those arising from AFE with cardiac arrest.