Title : A Case of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) with Co-application of Impella in a Patient with Late Peripartum Cardiac Arrest Secondary to Amniotic Fluid Embolism
Abstract:
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy that accounts for nearly 1 in 5 maternal deaths globally. Of these deaths, nearly half of them occur within one hour of symptom onset. Therefore, prompt and aggressive resuscitation strategies are crucial in promoting survivability. The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has only recently expanded to include such patient populations. We present a case of a mother with a relatively uncomplicated pregnancy who presented to the emergency room late in her third trimester for shortness of breath which rapidly progressed to ARDS. Emergent cesarean section was performed, and a viable healthy newborn was successfully delivered. Immediately after the infant was delivered, the mother had a cardiac arrest. Cardiopulmonary resuscitation was successful after 4 minutes. Subsequent transthoracic echo (TTE) revealed biventricular failure with a severely reduced ejection fraction (EF) of 0-5%. Additionally, she rapidly developed disseminated intravascular coagulation (DIC) and oliguric renal failure. The decision was made to perform emergent VA-ECMO with co-application of Impella. Repeat TTE post-op showed improvement in EF to 30-35% with moderately reduced RV function. Our patient successfully had complete resolution of cardiogenic shock, DIC, renal failure, and ARDS within 5 days. Serial TTE continued to show improvement in cardiac function throughout the hospitalization course. Patient was subsequently discharged to inpatient rehabilitation unit after continued clinical improvement. Thus, we were able to both safely deliver the baby and successfully resuscitate the mother with the novel combination of VA-ECMO and Impella. This combination is known as ECPELLA, a very new concept that is quickly gaining popularity and world-wide recognition. Therefore, it is imperative to report such novel applications in unique patient populations as well as their outcomes.
