Early application of modified A-OK protocol for amniotic fluid embolism: Case series report

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency with high mortality, characterized by sudden cardiovascular collapse, hypoxia, and coagulopathy. Current management is primarily supportive, but emerging case reports suggest a potential benefit from a novel regimen combining atropine, ondansetron, and ketorolac (A-OK). However, due to AFE's extreme rarity, large-scale studies are lacking.

Three women with suspected AFE presented with acute hemodynamic instability, hypoxia, or coagulopathy during or shortly after delivery.

AFE was clinically diagnosed based on sudden cardiovascular collapse, respiratory distress, and coagulopathy in the peripartum setting.

A modified A-OK protocol, atropine, granisetron (replacing ondansetron), and lornoxicam (replacing ketorolac) (A-GL), was administered early alongside standard resuscitation measures.

Rapid hemodynamic stabilization and improved oxygenation were observed within minutes of A-GL administration. All 3 patients survived with favorable outcomes.

These cases suggest that early A-OK-based therapy (or its modified A-GL regimen) may improve outcomes in AFE. Further research is warranted to validate this approach and refine treatment protocols.