Successful management of intrapartum pulmonary embolism causing cardiac arrest using thrombolysis, CPR, and VA-ECMO, resulting in maternal and fetal survival without neurological deficit.
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Raises suspicion for PE in peripartum arrest; leaves open the role of TEE during obstetric resuscitation.
We report the sudden onset of dyspnea and loss of consciousness and fetal bradycardia in a middle-aged obese nulliparous woman at 39 weeks of gestation during first stage of labor leading to the decision for emergency cesarean section. Still during surgery, the mother underwent cardiac arrest. Transesophageal echocardiography during resuscitation showed right ventricular failure leading to the diagnosis of pulmonary embolism. Return of spontaneous circulation was achieved after emergency administration of thrombolysis with alteplase and cardiopulmonary resuscitation after 40 min. Severe bleeding, coagulopathy and persistent right ventricular failure resulted in persistent hemodynamic instability leading to supracervical hysterectomy and veno-arterial extracorporal life support. Both mother and baby survived without hypoxic brain injury.
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Killinger et al. (2024) studied this question.
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