title: Survival after an amniotic fluid embolism following the use of sodium bicarbonate.
abstract: Amniotic fluid embolism (AFE) is a rare and potentially fatal complication of pregnancy. In this case report, we highlight the successful use of sodium bicarbonate in a patient with an AFE. We present a case of a 38-year-old mother admitted for an elective caesarean section. Following the delivery of her baby, the mother suffered a cardiac arrest. Following a protracted resuscitation, transoesophageal echocardiography demonstrated evidence of acute pulmonary hypertension, with an empty left ventricle and an over-distended right ventricle. In view of these findings and no improvement noted from on-going resuscitation, sodium bicarbonate was infused as a pulmonary vasodilator. Almost instantaneous return of spontaneous circulation was noted, with normalisation of cardiac parameters. We propose that in patients suspected with AFE and who have been unresponsive to advance cardiac life support measures, and where right ventricular failure is present with acidosis and/or hypercarbia, the use of sodium bicarbonate should be considered.
authors.affiliation: Department of Anaesthesia, Townsville Hospital, Douglas, Queensland, Australia.
authors.forename: Sorcha
authors.initials: S
authors.lastname: Evans
authors.affiliation: Department of Anaesthesia, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
authors.forename: Brigid
authors.initials: B
authors.lastname: Brown
authors.affiliation: Department of Anaesthesia, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mathieson
authors.affiliation: Department of Anaesthesia, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
authors.forename: Stan
authors.initials: S
authors.lastname: Tay
mesh_terms: D000328:Adult; D004619:Embolism, Amniotic Fluid / Q000188:drug therapy*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology; D011247:Pregnancy; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D017693:Sodium Bicarbonate