Extracorporeal membrane oxygenation in the acute treatment of cardiovascular collapse immediately post-partum.
We describe the use of extracorporeal membrane oxygenation (ECMO) in a 30-year old woman at 37 weeks' gestation, following cardiac arrest from pulmonary embolism immediately post-partum from an emergent Caesarean section. In this case, ECMO was initiated though modified techniques with only the equipment available in a delivery room as a last resort to save a new mother after a significant downtime of 83 min. The patient received tissue plasminogen activator during the resuscitation resulting in significant blood loss. However, the patient was stabilized on ECMO and after 5 weeks in the intensive care unit achieved complete physical and neurologic recovery. To our knowledge, this is the first reported case where ECMO has been used in a resuscitation from massive pulmonary embolism immediately post-partum, after thombolytics were administered. Here, we discuss our strategies for emergent cannulation in a suboptimal environment, management of profound bleeding and oxygenation strategies in this hostile setting. Given the potential for success and the significant life-years gained, aggressive measures, such as ECMO, should be considered in such extreme life-threatening cases.
Division of General Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada.
W Robert
WR
Leeper
Matthew
M
Valdis
Robert
R
Arntfield
L
L
Ray Guo
D000208:Acute Disease; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D002585:Cesarean Section; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012769:Shock / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
Extracorporeal membrane oxygenation; Post-partum arrest; Saddle pulmonary embolism