Amniotic fluid embolism is a rare obstetric emergency that can be accompanied by profound hypoxemia, coagulopathy, hemorrhage, and cardiogenic shock. Extracorporeal membrane oxygenation may provide a rescue strategy in amniotic fluid embolism with cardiopulmonary collapse. Approaches to anticoagulation must be balanced against the risk of hemorrhage with concomitant coagulopathy. Although extracorporeal membrane oxygenation has been described for cardiopulmonary collapse in the setting of amniotic fluid embolism, its initiation as a bridge to hemostasis and cardiopulmonary recovery in amniotic fluid embolism-induced hemorrhagic and cardiogenic shock remains a novel resuscitation strategy.
Design subject and intervention: We present a case detailing the initiation of extracorporeal life support with veno-arterio-venous extracorporeal membrane oxygenation in a patient with hemorrhagic shock and cardiopulmonary failure due to amniotic fluid embolism. The patient was ultimately discharged home 19 days after presentation free from neurologic or other significant disability.
Main results and conclusion: Through this case, we describe a tailored approach to extracorporeal life support initiation and advanced extracorporeal membrane oxygenation management as a bridge to recovery in patients with mixed shock. Additionally, we discuss how the culmination of prehospital, outpatient and inpatient provider teamwork, easily portable extracorporeal membrane oxygenation equipment, and multispecialty collaboration can afford promising therapeutic options for patients who were previously deemed ineligible for extracorporeal life support.
Keywords: amniotic fluid embolism; extracorporeal life support; extracorporeal membrane oxygenation; hemorrhagic shock.
Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.