title: A Case of Successful Thromboelastographic Guided Resuscitation after Postpartum Hemorrhage and Cardiac Arrest.
abstract: Amniotic fluid embolism (AFE) is an unusual cause of life threatening peri partum hemorrhage (PPH). AFE resuscitation is often associated with renal and respiratory insufficiency, and a coagulopathy similar to disseminated intravascular coagulation (DIC). Resuscitation requires immediate recognition and limited use of crystalloid. We present a case of PPH caused by AFE with resultant cardiac arrest, renal and respiratory failure, and DIC-like coagulopathy, whose successful resuscitation was guided by perfusionist-directed serial thromboelastography (TEG). Viscoelastic tests (VET)s, including the TEG and rotational thromboelastometry (ROTEM), may provide more individualized blood component therapy (BCT) in the treatment of severe PPH associated with AFE as has been previously noted with trauma resuscitation in the literature. However, VET's efficacy is often limited by a lack of standardization, quality assurance norms, and consistent operator proficiency. We suggest that there may be a role for perfusionsts adept at utilizing TEG in the optimization of BCT and adjunctive hemostatic agents in severely hemorrhagic patients. This patient's successful resuscitation demonstrates the importance of resuscitation guided by the perfusionist or other medical professionals with expertise in TEG guided resuscitation and how the administration of specific blood products and hemostatic agents guided by the TEG can help optimize patient outcomes in comparison to traditional 1:1:1 packed red blood cells (PRBC) /fresh frozen plasma (FFP) /platelets ratios given to severely hemorrhaging patients.
authors.affiliation: Department of Anesthesiology, Memorial Hospital, South Bend, Indiana.
authors.forename: M
authors.initials: M
authors.lastname: Hurwich
authors.affiliation: Indiana University School of Medicine, South Bend at the Notre Dame Campus, South Bend, Indiana.
authors.forename: D
authors.initials: D
authors.lastname: Zimmer
authors.affiliation: Department of Anesthesiology, Memorial Hospital, South Bend, Indiana.
authors.forename: E
authors.initials: E
authors.lastname: Guerra
authors.affiliation: Department of Anesthesiology, Memorial Hospital, South Bend, Indiana.
authors.forename: E
authors.initials: E
authors.lastname: Evans
authors.affiliation: Department of Anesthesiology, Memorial Hospital, South Bend, Indiana.
authors.forename: T
authors.initials: T
authors.lastname: Shire
authors.affiliation: Depatrment of Maternal-Fetal Medicine, St. Vincent Hospital, Indianapolis, Indiana.
authors.forename: M
authors.initials: M
authors.lastname: Abernathy
authors.affiliation: Indiana University School of Medicine, South Bend at the Notre Dame Campus, South Bend, Indiana.
authors.forename: J T
authors.initials: JT
authors.lastname: Shreve
authors.affiliation: Indiana University School of Medicine, South Bend at the Notre Dame Campus, South Bend, Indiana.
authors.forename: G R
authors.initials: GR
authors.lastname: Kolettis
authors.affiliation: Departments of Critical Care and Emergency Medicine, University of Maryland School of Medicine Baltimore, Maryland.
authors.forename: M T
authors.initials: MT
authors.lastname: McCurdy
authors.affiliation: Indiana University School of Medicine, South Bend at the Notre Dame Campus, South Bend, Indiana.; W.M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana.
authors.forename: F J
authors.initials: FJ
authors.lastname: Castellino
authors.affiliation: Indiana University School of Medicine, South Bend at the Notre Dame Campus, South Bend, Indiana.; W.M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana.
authors.forename: M
authors.initials: M
authors.lastname: Walsh
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000097:blood* / Q000628:therapy*; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome
keywords: amniotic fluid; blood component transfusion; embolism; postpartum hemorrhage; thromboelastography; tranexamic acid