Amniotic fluid embolism: principles of early clinical management

Luis Pacheco, Steven L. Clark, Miranda Klassen, Gary D.V. Hankins

Research output: Contribution to journalArticle

Abstract

Amniotic fluid embolism is an uncommon, but potentially lethal, complication of pregnancy. Because amniotic fluid embolism usually is seen with cardiac arrest, the initial immediate response should be to provide high-quality cardiopulmonary resuscitation. We describe key features of initial treatment of patients with amniotic fluid embolism. Where available, we recommend performing transthoracic or transesophageal echocardiography as soon as possible because this is an easy and reliable method of identifying a failing right ventricle. If such failure is identified, treatment that is tailored at improving right ventricular performance should be initiated with the use of inotropic agents and pulmonary vasodilators. Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. Amniotic fluid embolism–related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen of >150–200 mg/dL). In cases that require prolonged cardiopulmonary resuscitation or, after arrest, severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.

Original languageEnglish (US)
JournalAmerican journal of obstetrics and gynecology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Amniotic Fluid Embolism
Cardiopulmonary Resuscitation
Ventricular Dysfunction
Extracorporeal Membrane Oxygenation
Pregnancy Complications
Transesophageal Echocardiography
Hemostatics
Amniotic Fluid
Heart Arrest
Vasodilator Agents
Resuscitation
Fibrinogen
Heart Ventricles
Echocardiography
Blood Platelets
Blood Pressure
Lung
Therapeutics
Serum

Keywords

  • blood product
  • cardiac arrest
  • coagulation
  • cryoprecipitate
  • dobutamine
  • norepinephrine
  • platelet
  • right ventricular failure

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Amniotic fluid embolism : principles of early clinical management. / Pacheco, Luis; Clark, Steven L.; Klassen, Miranda; Hankins, Gary D.V.

In: American journal of obstetrics and gynecology, 01.01.2019.

Research output: Contribution to journalArticle

@article{968a98bc01d94ce9825812182582bc1c,
title = "Amniotic fluid embolism: principles of early clinical management",
abstract = "Amniotic fluid embolism is an uncommon, but potentially lethal, complication of pregnancy. Because amniotic fluid embolism usually is seen with cardiac arrest, the initial immediate response should be to provide high-quality cardiopulmonary resuscitation. We describe key features of initial treatment of patients with amniotic fluid embolism. Where available, we recommend performing transthoracic or transesophageal echocardiography as soon as possible because this is an easy and reliable method of identifying a failing right ventricle. If such failure is identified, treatment that is tailored at improving right ventricular performance should be initiated with the use of inotropic agents and pulmonary vasodilators. Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. Amniotic fluid embolism–related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen of >150–200 mg/dL). In cases that require prolonged cardiopulmonary resuscitation or, after arrest, severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.",
keywords = "blood product, cardiac arrest, coagulation, cryoprecipitate, dobutamine, norepinephrine, platelet, right ventricular failure",
author = "Luis Pacheco and Clark, {Steven L.} and Miranda Klassen and Hankins, {Gary D.V.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ajog.2019.07.036",
language = "English (US)",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Amniotic fluid embolism

T2 - principles of early clinical management

AU - Pacheco, Luis

AU - Clark, Steven L.

AU - Klassen, Miranda

AU - Hankins, Gary D.V.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Amniotic fluid embolism is an uncommon, but potentially lethal, complication of pregnancy. Because amniotic fluid embolism usually is seen with cardiac arrest, the initial immediate response should be to provide high-quality cardiopulmonary resuscitation. We describe key features of initial treatment of patients with amniotic fluid embolism. Where available, we recommend performing transthoracic or transesophageal echocardiography as soon as possible because this is an easy and reliable method of identifying a failing right ventricle. If such failure is identified, treatment that is tailored at improving right ventricular performance should be initiated with the use of inotropic agents and pulmonary vasodilators. Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. Amniotic fluid embolism–related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen of >150–200 mg/dL). In cases that require prolonged cardiopulmonary resuscitation or, after arrest, severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.

AB - Amniotic fluid embolism is an uncommon, but potentially lethal, complication of pregnancy. Because amniotic fluid embolism usually is seen with cardiac arrest, the initial immediate response should be to provide high-quality cardiopulmonary resuscitation. We describe key features of initial treatment of patients with amniotic fluid embolism. Where available, we recommend performing transthoracic or transesophageal echocardiography as soon as possible because this is an easy and reliable method of identifying a failing right ventricle. If such failure is identified, treatment that is tailored at improving right ventricular performance should be initiated with the use of inotropic agents and pulmonary vasodilators. Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. Amniotic fluid embolism–related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen of >150–200 mg/dL). In cases that require prolonged cardiopulmonary resuscitation or, after arrest, severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.

KW - blood product

KW - cardiac arrest

KW - coagulation

KW - cryoprecipitate

KW - dobutamine

KW - norepinephrine

KW - platelet

KW - right ventricular failure

UR - http://www.scopus.com/inward/record.url?scp=85070710843&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070710843&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2019.07.036

DO - 10.1016/j.ajog.2019.07.036

M3 - Article

AN - SCOPUS:85070710843

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

ER -