VA-ECMO served as a vital bridge to full cardiac, pulmonary, and renal recovery in a 30-year-old woman with refractory shock and biventricular failure due to amniotic fluid embolism.
Case Report (n=1)
VA-ECMO can serve as a successful bridge to recovery for patients with refractory shock and biventricular failure secondary to amniotic fluid embolism.
Abstract Introduction Amniotic fluid embolism (AFE) is a rare, catastrophic obstetric emergency characterized by abrupt cardiovascular collapse, hypoxemia, and coagulopathy, often occurring during labor, delivery, or the immediate postpartum period. Prompt recognition and multidisciplinary intervention are essential. We report a case of massive AFE during labor resulting in cardiac arrest, disseminated intravascular coagulation (DIC), and hemodynamic instability, managed with perimortem cesarean delivery, massive transfusion, and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Case Presentation A 30-year-old G2P1 woman at 38 weeks gestation with a history of gestational hypertension, asthma, and obesity was admitted for elective induction of labor. Shortly after artificial rupture of membranes, she became flushed and nauseated, then abruptly lost consciousness with tonic-clonic activity. Perimortem cesarean section was performed due to persistent fetal bradycardia, upon arrival to the operating room patient developed pulseless electrical activity (PEA). Return of spontaneous circulation (ROSC) was achieved after four cycles of ACLS. Given the abrupt cardiovascular collapse, coagulopathy, and severe hypoxemia, AFE was strongly suspected. She was noted to have profound hypoxemia despite maximal ventilatory support, and chest radiography (Figure 1) demonstrated diffuse bilateral airspace opacities consistent with acute respiratory distress syndrome (ARDS). Point-of-care ultrasound revealed biventricular dysfunction. Despite maximal medical therapy, persistent hemodynamic instability necessitated VA-ECMO. Intra-abdominal hemorrhage(Figure 2) and abdominal compartment syndrome required exploratory laparotomy and further transfusion. Acute kidney injury with hyperkalemia was managed with continuous renal replacement therapy. The patient achieved full cardiac, pulmonary, and renal recovery, with ECMO decannulation on ICU Day 2, extubation on day 4, and discharge home with a healthy infant. Discussion AFE remains one of the most feared obstetric emergencies due to its sudden onset, diagnostic uncertainty, and high mortality. Diagnosis is clinical, based on the abrupt onset of hypoxia, hypotension, altered mental status, and DIC during labor or within 30 minutes postpartum, and requires exclusion of other causes. Management is supportive, focusing on hemodynamic stabilization and coagulopathy correction. In this case, rapid identification of AFE and biventricular failure via ultrasound enabled timely VA-ECMO initiation. Multidisciplinary coordination was key to managing ARDS, DIC, and hemorrhagic shock, facilitating full recovery. Conclusion This case highlights the fulminant presentation of AFE and the critical role of rapid, multidisciplinary intervention. VA-ECMO served as a vital bridge to recovery in refractory shock and biventricular failure. Early recognition, point-of-care ultrasound, and coordinated care were pivotal to achieving an excellent maternal and fetal outcome, demonstrating the potential for recovery in catastrophic obstetric emergencies. This abstract is funded by: None
Lemus et al. (Fri,) conducted a case report in Amniotic fluid embolism (n=1). VA-ECMO was evaluated on Clinical recovery. VA-ECMO served as a vital bridge to full cardiac, pulmonary, and renal recovery in a 30-year-old woman with refractory shock and biventricular failure due to amniotic fluid embolism.