European Journal of Cardiovascular Medicine

Introduction: Amniotic fluid embolism (AFE) is remarkably infrequent yet carries a high mortality rate when it occurs. Here we report a case of AFE which was complicated by cardiac arrest, severe acute respiratory distress syndrome, and disseminated intravascular coagulopathy that was treated via our Mobile ECMO program. Case presentation: A 29-year-old gravid female at 40.5 weeks of gestation who experienced sudden hemodynamic instability secondary to AFE during labor. The patient exhibited a generalized tonic-clonic seizure, which was followed by pulseless electrical activity, necessitating emergent delivery via cesarean section of a healthy neonate. The patient’s condition continued to worsen and she suffered multiple cardiac arrest events, hypoxemia, and massive uterine bleeding. Due to hemodynamic compromise, the mobile extracorporeal membrane oxygenation (ECMO) team was activated and the patient was placed on a veno-arterial (VA ECMO) circuit. Subsequently, the patient developed abdominal compartment syndrome and required a bedside exploratory laparotomy. Following this intervention, the patient's hemodynamics stabilized, her cardiac and respiratory function improved, and VA ECMO was able to be removed on the fourth day. The patient remained neurologically intact and eventually was transferred to a rehabilitation facility. Discussion: Despite recent advances in prenatal care, AFE remains a significant and potentially fatal complication of parturition. Early recognition and prompt treatment are important, and refractory cardiopulmonary collapse can be supported with VA ECMO. The mobile ECMO program increases access to this life saving technology. Conclusion: Our report underscores the efficacy of ECMO as a therapeutic modality for AFE and the benefit of mobile ECMO in expanding access for this life saving technology.