Extracorporeal cardiopulmonary resuscitation for maternal cardiac arrest secondary to amniotic fluid embolism during...

Amniotic fluid embolism (AFE) is a rare complication of pregnancy with high morbidity and mortality. A healthy 33-year-old G4P2012 woman at 39 + 2 weeks presented for an external cephalic version (ECV). During ECV attempts, the patient experienced sudden onset cardiac arrest. Emergent resuscitative delivery was performed followed by emergent application of extracorporeal cardiopulmonary resuscitation via peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) due to profound maternal hemodynamic instability. The patient developed postpartum hemorrhage and disseminated intravascular coagulopathy, necessitating massive transfusion. Post-delivery, a posterior circulation stroke was discovered, possibly due to paradoxical emboli in the setting of a previously undiagnosed patent foramen ovale. Both the patient and the neonate recovered and discharged home. This case highlights successful intervention of VA-ECMO with favorable maternal and neonatal outcomes following maternal cardiac arrest that was highly suspicious for amniotic fluid embolism. Prompt delivery, early ECMO activation, and multidisciplinary care were pivotal in the favorable outcomes.