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CC BY 4.0 · Z Geburtshilfe Neonatol
DOI: 10.1055/a-2685-9833
Case Report

Management of Amniotic Fluid Embolism (AFE) using anticoagulation-free ECMO

Peijie Yan
1   Department of Critical Care Medicine, Weifang People's Hospital, Shandong Second Medical University, Weifang, China (Ringgold ID: RIN372527)
2   School of Clinical Medicine, Shandong Second Medical University, Weifang, China (Ringgold ID: RIN117907)
,
Chuihua Sun
1   Department of Critical Care Medicine, Weifang People's Hospital, Shandong Second Medical University, Weifang, China (Ringgold ID: RIN372527)
,
Xiaoyan Ma
1   Department of Critical Care Medicine, Weifang People's Hospital, Shandong Second Medical University, Weifang, China (Ringgold ID: RIN372527)
,
Xin Sun
1   Department of Critical Care Medicine, Weifang People's Hospital, Shandong Second Medical University, Weifang, China (Ringgold ID: RIN372527)
,
Liming Wang
1   Department of Critical Care Medicine, Weifang People's Hospital, Shandong Second Medical University, Weifang, China (Ringgold ID: RIN372527)
,
Qinghai Zhang
1   Department of Critical Care Medicine, Weifang People's Hospital, Shandong Second Medical University, Weifang, China (Ringgold ID: RIN372527)
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This work was supported by Key Specialty Funds for the Intensive Care Medicine Department at Weifang People's Hospital for article processing charge.
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Erratum zu diesem Artikel:

Correction: Management of Amniotic Fluid Embolism (AFE) using anticoagulation-free ECMOZ Geburtshilfe Neonatol eFirst
DOI: 10.1055/a-2707-9802

Abstract

Amniotic fluid embolism (AFE) is a critical obstetric complication characterized by the entry of amniotic fluid and its components into maternal circulation during parturition, leading to acute cardiopulmonary failure, disseminated intravascular coagulation (DIC), and anaphylactic shock. Affected patients typically exhibit abrupt onset, rapid progression, and exceedingly high mortality. Early recognition and prompt intervention are pivotal in AFE management. We present a case of AFE-induced cardiac arrest in a 35-year-old primigravida who developed acute cardiopulmonary collapse during vaginal delivery, followed by cardiac arrest. After cardiopulmonary resuscitation, massive transfusion, and crash emergency cesarean section, anticoagulant-free venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated. Subsequent multimodal therapies – including aggressive transfusion support, uterine artery embolization for hemostasis, exploratory laparotomy, and targeted DIC management – ensured safe ECMO maintenance without device-related complications. By hospital day 3, hemodynamic and respiratory stability were achieved, enabling successful ECMO weaning. This case highlights that ECMO remains a viable therapeutic option for salvaging critically ill AFE patients with refractory hemorrhagic shock, DIC, and cardiopulmonary failure.

Keywords

Amniotic Fluid Embolism - disseminated intravascular coagulation - VA-ECMO - anticoagulation-free


Publikationsverlauf

Eingereicht: 05. Mai 2025

Angenommen nach Revision: 05. August 2025

Artikel online veröffentlicht:
05. September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Lisonkova S, Kramer MS. Amniotic fluid embolism: A puzzling and dangerous obstetric problem. PLoS Med 2019; 16: e1002976
    Suche in Google Scholar
  • 2 Golzarian H, Mariam A, Shah SR. et al. Amniotic fluid embolism-induced cardiopulmonary collapse successfully treated with combination VA-ECMO and Impella CP. ESC Heart Fail 2023; 10: 1440-1444
    Suche in Google Scholar
  • 3 Fitzpatrick KE, Tuffnell D, Kurinczuk JJ. et al. Incidence, risk factors, management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study. BJOG 2016; 123: 100-109
    Suche in Google Scholar
  • 4 Pacheco LD, Saade G, Hankins GD. et al. Amniotic fluid embolism: diagnosis and management. Am J Obstet Gynecol 2016; 215: B16-B24
    Suche in Google Scholar
  • 5 Oda T, Tamura N, Yata D. et al. A case of consumptive coagulopathy before cardiopulmonary failure in amniotic fluid embolism and review of literature: A perspective of the latent onset and progression of coagulopathy. Cureus 2024; 16: e55961
    Suche in Google Scholar
  • 6 Barakat M, Alamami A, Ait Hssain A. Recurrent cardiac arrests due to amniotic fluid embolism. Cureus 2022; 14: e22475
    Suche in Google Scholar
  • 7 Lao TT. Acute respiratory distress and amniotic fluid embolism in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85: 83-95
    Suche in Google Scholar
  • 8 Yang RL, Lang MZ, Li H, Qiao XM. Immune storm and coagulation storm in the pathogenesis of amniotic fluid embolism. Eur Rev Med Pharmacol Sci 2021; 25: 1796-1803
    Suche in Google Scholar
  • 9 Trieu NHK, Nguyen NN, Pham HM. et al. Extracorporeal membrane oxygenation in amniotic fluid embolism: A systematic review of case reports. ASAIO J 2025; 71: 143-148
    Suche in Google Scholar
  • 10 Aissi James S, Klein T, Lebreton G. et al. Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation. Crit Care 2022; 26: 96
    Suche in Google Scholar
  • 11 Metodiev Y, Ramasamy P, Tuffnell D. Amniotic fluid embolism. BJA Educ 2018; 18: 234-238
    Suche in Google Scholar
  • 12 Panda S, Das A, Sharma N. et al. Amniotic fluid embolism after first-trimester abortion. Cureus 2022; 14: e24490
    Suche in Google Scholar
  • 13 Zeibi Shirejini S, Carberry J, McQuilten ZK. et al. Current and future strategies to monitor and manage coagulation in ECMO patients. Thromb J 2023; 21: 11
    Suche in Google Scholar
  • 14 Chlebowski MM, Baltagi S, Carlson M. et al. Clinical controversies in anticoagulation monitoring and antithrombin supplementation for ECMO. Crit Care 2020; 24: 19
    Suche in Google Scholar
  • 15 Erez O, Othman M, Rabinovich A. et al. DIC in pregnancy – pathophysiology, clinical characteristics, diagnostic scores, and treatments. J Blood Med 2022; 13: 21-44
    Suche in Google Scholar
  • 16 Moon SH, Kim KN, Jung JJ. et al. Heparin-free veno-venous ECMO applied to a patient with severe lung contusion and hypovolemic shock due to trauma. Ulus Travma Acil Cerrahi Derg 2018; 24: 497-500
    Suche in Google Scholar