title: Successful provision of inter-hospital extracorporeal cardiopulmonary resuscitation for acute post-partum pulmonary embolism.
abstract: Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived. Following ECMO support, the patient experienced massive hemorrhage which was managed with uterotonic agents, targeted transfusion, bilateral uterine artery embolisation and abdominal re-exploration. The patient was transferred to an adult unit where she remained on ECMO for five days. She was discharged home with normal cognitive function. This case highlights the role ECMO plays in providing extracorporeal respiratory or mechanical circulatory support in a high risk obstetric patient.
authors.affiliation: The Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Chermside, Australia. Electronic address: charles.mcdonald@health.qld.gov.au.
authors.forename: C
authors.initials: C
authors.lastname: McDonald
authors.affiliation: Department of Obstetric Medicine, Mater Health Services, South Brisbane, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Laurie
authors.affiliation: Obstetrics and Gynaecology, Mater Health Services, South Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Janssens
authors.affiliation: Queensland Paediatric Cardiac Service, The Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Zazulak
authors.affiliation: Department of Anaesthesia, Mater Health Services, South Brisbane, Queensland, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Kotze
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia; Adult Intensive Care Service, The Prince Charles Hospital, Chermside, Queensland, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Shekar
mesh_terms: D000792:Angiography; D001803:Blood Transfusion; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D017128:Embolectomy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
keywords: Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Post-partum; Pulmonary embolism