Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation
Abstract Background Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC). Although few case reports have reported successful use of venoarterial extracorporeal membr...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-03969-3 |
| _version_ | 1819210484538146816 |
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| author | Sarah Aissi James Thomas Klein Guillaume Lebreton Jacky Nizard Juliette Chommeloux Nicolas Bréchot Marc Pineton de Chambrun Guillaume Hékimian Charles-Edouard Luyt Bruno Levy Antoine Kimmoun Alain Combes Matthieu Schmidt |
| author_facet | Sarah Aissi James Thomas Klein Guillaume Lebreton Jacky Nizard Juliette Chommeloux Nicolas Bréchot Marc Pineton de Chambrun Guillaume Hékimian Charles-Edouard Luyt Bruno Levy Antoine Kimmoun Alain Combes Matthieu Schmidt |
| author_sort | Sarah Aissi James |
| collection | DOAJ |
| description | Abstract Background Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC). Although few case reports have reported successful use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks with that device. Methods This study included patients with AFE rescued by VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and February 2021. Clinical characteristics, critical care management, in-intensive care unit (ICU) complications, and hospital outcomes were collected. ICU survivors were assessed for health-related quality of life (HRQL) in May 2021. Results During that 13-year study period, VA-ECMO was initiated in 54 parturient women in two high ECMO volume centers. Among that population, 10 patients with AFE [median (range) age 33 (24–40), SAPS II at 69 (56–81)] who fulfilled our diagnosis criteria were treated with VA-ECMO. Pregnancy evolved for 36 (30–41) weeks. Seven patients had a cardiac arrest before ECMO and two were cannulated under cardiopulmonary resuscitation. Pre-ECMO hemodynamic was severely impaired with an inotrope score at 370 (55–1530) μg/kg/min, a severe left ventricular ejection fraction measured at 14 (0–40)%, and lactate at 12 (2–30) mmol/L. 70% of these patients were alive at hospital discharge despite an extreme pre-ECMO severity and massive blood product transfusion. However, HRQL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up. Conclusion In this rare per-delivery complication, our results support the use of VA-ECMO despite intense DIC and ongoing bleeding. Future studies should focus on customized, patient-centered, rehabilitation programs that could lead to improved HRQL in this population. |
| first_indexed | 2024-12-23T06:11:55Z |
| format | Article |
| id | doaj.art-c2cf772ee01e487fac1785aa122c0028 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-23T06:11:55Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-c2cf772ee01e487fac1785aa122c00282022-12-21T17:57:26ZengBMCCritical Care1364-85352022-04-012611810.1186/s13054-022-03969-3Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenationSarah Aissi James0Thomas Klein1Guillaume Lebreton2Jacky Nizard3Juliette Chommeloux4Nicolas Bréchot5Marc Pineton de Chambrun6Guillaume Hékimian7Charles-Edouard Luyt8Bruno Levy9Antoine Kimmoun10Alain Combes11Matthieu Schmidt12Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreUniversité de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCTInstitute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICANDepartment of Gynaecology and Obstetrics, Groupe Hospitalier Pitié-Salpêtrière, CNRS UMR 7222, INSERM U1150, Sorbonne UniversitésService de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreService de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreService de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreService de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreService de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreUniversité de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCTUniversité de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCTService de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreService de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–SalpêtrièreAbstract Background Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC). Although few case reports have reported successful use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks with that device. Methods This study included patients with AFE rescued by VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and February 2021. Clinical characteristics, critical care management, in-intensive care unit (ICU) complications, and hospital outcomes were collected. ICU survivors were assessed for health-related quality of life (HRQL) in May 2021. Results During that 13-year study period, VA-ECMO was initiated in 54 parturient women in two high ECMO volume centers. Among that population, 10 patients with AFE [median (range) age 33 (24–40), SAPS II at 69 (56–81)] who fulfilled our diagnosis criteria were treated with VA-ECMO. Pregnancy evolved for 36 (30–41) weeks. Seven patients had a cardiac arrest before ECMO and two were cannulated under cardiopulmonary resuscitation. Pre-ECMO hemodynamic was severely impaired with an inotrope score at 370 (55–1530) μg/kg/min, a severe left ventricular ejection fraction measured at 14 (0–40)%, and lactate at 12 (2–30) mmol/L. 70% of these patients were alive at hospital discharge despite an extreme pre-ECMO severity and massive blood product transfusion. However, HRQL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up. Conclusion In this rare per-delivery complication, our results support the use of VA-ECMO despite intense DIC and ongoing bleeding. Future studies should focus on customized, patient-centered, rehabilitation programs that could lead to improved HRQL in this population.https://doi.org/10.1186/s13054-022-03969-3Extracorporeal membrane oxygenationAmniotic fluid embolismCardiogenic shockDisseminated intravascular coagulopathyOutcomes |
| spellingShingle | Sarah Aissi James Thomas Klein Guillaume Lebreton Jacky Nizard Juliette Chommeloux Nicolas Bréchot Marc Pineton de Chambrun Guillaume Hékimian Charles-Edouard Luyt Bruno Levy Antoine Kimmoun Alain Combes Matthieu Schmidt Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation Critical Care Extracorporeal membrane oxygenation Amniotic fluid embolism Cardiogenic shock Disseminated intravascular coagulopathy Outcomes |
| title | Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation |
| title_full | Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation |
| title_fullStr | Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation |
| title_full_unstemmed | Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation |
| title_short | Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation |
| title_sort | amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation |
| topic | Extracorporeal membrane oxygenation Amniotic fluid embolism Cardiogenic shock Disseminated intravascular coagulopathy Outcomes |
| url | https://doi.org/10.1186/s13054-022-03969-3 |
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