title: Amniotic Fluid Embolism: Using the Medical Staff Process to Facilitate Streamlined Care.
abstract: Amniotic fluid embolism (AFE) is a catastrophic consequence of labor and delivery that often results in maternal and neonatal death. These poor outcomes are related largely to the rarity of the event in a population overwhelmingly biased by overall good health. Despite the presence of national AFE registries, there are no published algorithmic approaches to its management, to our knowledge. The purpose of this article is to share a care pathway developed by a multidisciplinary group at a community teaching hospital. Post hoc analysis of a complicated case of AFE resulted in development of this pathway, which addresses many of the major consequences of AFE. We offer this algorithm as a template for use by any institution willing to implement a clinical pathway to treat AFE. It is accompanied by the remarkable case outcome that prompted its development.
authors.affiliation: Cardiac Anesthesiologist at Saint Joseph Hospital in Denver, CO. peter.hession@sclhs.net.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hession
authors.affiliation: Chief Resident in General Surgery at Saint Joseph Hospital in Denver, CO. cynthia.japhet@sclhs.net.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Millward
authors.affiliation: Attending Obstetrician/Gynecologist at the Franklin Medical Center in Denver, CO. joyce.e.gottesfeld@kp.org.
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Gottesfeld
authors.affiliation: Director of Quality, Colorado Permanente Medical Group in Denver. thomas.f.rehring@kp.org.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Rehring
authors.affiliation: Cardiac Surgeon at Saint Joseph Hospital in Denver, CO. kevin.miller@sclhs.net.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Miller
authors.affiliation: Cardiac Anesthesiologist at the Franklin Medical Center in Denver, CO. paul.chetham@kp.org.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Chetham
authors.affiliation: General Surgeon at the Englewood Medical Center in Denver, CO. stephen.k.muckleroy@kp.org.
authors.forename: S Kel
authors.initials: SK
authors.lastname: Muckleroy
authors.affiliation: Critical Care Pulmonologist in the Department of Critical Care Pulmonology and Sleep Apnea at the Franklin Medical Center in Denver, CO. christopher.a.bates@kp.org.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Bates
authors.affiliation: Senior Research Advisor in the Department of Graduate Medical Education: General Surgery at Saint Joseph Hospital in Denver, CO. harriswhitt.hollisjr@sclhs.net.
authors.forename: Harris W
authors.initials: HW
authors.lastname: Hollis
mesh_terms: D000328:Adult; D000465:Algorithms; D002985:Clinical Protocols; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004619:Embolism, Amniotic Fluid / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008503:Medical Staff; D011247:Pregnancy; D012042:Registries