Cardiovascular Disease Fellow Department of Cardiovascular Disease, HCA Houston Healthcare - Kingwood/University of Houston College of Medicine, Houston, Texas, USA., United States
Background: We present a case of amniotic fluid embolism (AFE) resulting in cardiopulmonary collapse and cardiac arrest. We were able to safely deliver the baby and resuscitate the mother utilizing VA-ECMO and Impella CP. We discuss implications of this approach as an efficacious strategy in resuscitating AFE-induced cardiogenic shock and arrest.
Methods: The patient was provided standard therapy for AFE per the Society for Maternal‐Fetal Medicine guidelines. She was being sustained on high‐dose norepinephrine, epinephrine, and vasopressin. Right heart catheterization revealed no pulsatility in the pulmonary arteries, central venous pressure of 20 mmHg, pulmonary capillary wedge pressure of 17 mmHg, and a cardiac index of 1.8. The decision was then made to perform emergent VA‐ECMO with percutaneous left ventricular decompression using Impella CP (ECPELLA). To do this, we utilized a standard TandemLife system—two minimally invasive large‐bore catheters connected in series with an oxygenator and motorized pump that served to provide cardiopulmonary bypass. The patient was supported with as needed transfusions, inotropes, and pressors to ensure a mean arterial pressure above 65 mmHg, PaO2 70–100 mmHg, SvO2 > 60%, and central venous pressure of 10–15 mmHg.
Outcome: A repeat post‐procedural TTE on Day 3 revealed an improvement of her EF to 25–30% with moderately reduced right ventricular function. Serial echocardiograms continued to show improvement in cardiac function throughout the hospitalization course. By Day 5 on ECPELLA, she had total resolution of her cardiogenic shock. Our patient is now 3 years status‐post ECPELLA resuscitation and doing very well. Her EF remains 60-65% and she has no cardiopulmonary limitation to date.
Conclusion: Given the paucity of data and the difficulty in making such a diagnosis of amniotic fluid-induced cardiopulmonary collapse, physicians need to be aware of such presentations and the various approaches to management.
