Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery

다국어 초록 (Multilingual Abstract)

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately.
She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.

참고문헌 (Reference)

1 Estellés A, "Plasminogen activator inhibitors type 1 and type 2and plasminogen activators in amniotic fluid during pregnancy" 64 : 281-285, 1990

2 Walsh SW, "Peroxide induces vasoconstriction in the human placenta by stimulating thromboxane" 169 : 1007-1012, 1993

3 Stoeger A, "MRI findings in cerebral fat embolism" 8 : 1590-1593, 1998

4 Ecker JL, "Case 40-2012: a 43-year-old woman with cardiorespiratory arrest after a cesarean section" 367 : 2528-2536, 2012

5 Clark SL, "Amniotic fluid mbolism: ional registry" 172 : 1158-1167, 1995

6 Price TM, "Amniotic fluid embolism. Three case reports with a review of the literature" 40 : 462-465, 1985

7 Stanten RD, "Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction:diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass" 102 : 496-498, 2003

8 Gist RS, "Amniotic fluid embolism" 108 : 1599-1602, 2009

9 Moore J, "Amniotic fluid embolism" 33 : S279-S285, 2005