PMID- 35392980
OWN - NLM
STAT- MEDLINE
DCOM- 20220411
LR  - 20230410
IS  - 1466-609X (Electronic)
IS  - 1364-8535 (Print)
IS  - 1364-8535 (Linking)
VI  - 26
IP  - 1
DP  - 2022 Apr 7
TI  - Amniotic fluid embolism rescued by venoarterial extracorporeal membrane 
      oxygenation.
PG  - 96
LID - 10.1186/s13054-022-03969-3 [doi]
LID - 96
AB  - BACKGROUND: Amniotic fluid embolism (AFE) is a rare but often catastrophic 
      complication of pregnancy that leads to cardiopulmonary dysfunction and severe 
      disseminated intravascular coagulopathy (DIC). Although few case reports have 
      reported successful use of venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks 
      with that device. METHODS: This study included patients with AFE rescued by 
      VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and 
      February 2021. Clinical characteristics, critical care management, in-intensive 
      care unit (ICU) complications, and hospital outcomes were collected. ICU 
      survivors were assessed for health-related quality of life (HRQL) in May 2021. 
      RESULTS: During that 13-year study period, VA-ECMO was initiated in 54 parturient 
      women in two high ECMO volume centers. Among that population, 10 patients with 
      AFE [median (range) age 33 (24-40), SAPS II at 69 (56-81)] who fulfilled our 
      diagnosis criteria were treated with VA-ECMO. Pregnancy evolved for 36 (30-41) 
      weeks. Seven patients had a cardiac arrest before ECMO and two were cannulated 
      under cardiopulmonary resuscitation. Pre-ECMO hemodynamic was severely impaired 
      with an inotrope score at 370 (55-1530) mug/kg/min, a severe left ventricular 
      ejection fraction measured at 14 (0-40)%, and lactate at 12 (2-30) mmol/L. 70% of 
      these patients were alive at hospital discharge despite an extreme pre-ECMO 
      severity and massive blood product transfusion. However, HRQL was lower than 
      age-matched controls and still profoundly impaired in the role-physical, bodily 
      pain, and general health components after a median of 44 months follow-up. 
      CONCLUSION: In this rare per-delivery complication, our results support the use 
      of VA-ECMO despite intense DIC and ongoing bleeding. Future studies should focus 
      on customized, patient-centered, rehabilitation programs that could lead to 
      improved HRQL in this population.
CI  - (c) 2022. The Author(s).
FAU - Aissi James, Sarah
AU  - Aissi James S
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France.
FAU - Klein, Thomas
AU  - Klein T
AD  - Universite de Lorraine, CHRU de Nancy, Institut Lorrain du Coeur Et Des Vaisseaux, 
      Service de Medecine Intensive-Reanimation, U1116, FCRIN-INICRCT, Nancy, France.
FAU - Lebreton, Guillaume
AU  - Lebreton G
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France.
AD  - Service de Chirurgie Cardiaque, Institut de Cardiologie, APHP Sorbonne Universite 
      Hopital Pitie-Salpetriere, 75013, Paris, France.
FAU - Nizard, Jacky
AU  - Nizard J
AD  - Department of Gynaecology and Obstetrics, Groupe Hospitalier Pitie-Salpetriere, 
      CNRS UMR 7222, INSERM U1150, Sorbonne Universites, Paris, France.
FAU - Chommeloux, Juliette
AU  - Chommeloux J
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France.
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France.
FAU - Brechot, Nicolas
AU  - Brechot N
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France.
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France.
FAU - Pineton de Chambrun, Marc
AU  - Pineton de Chambrun M
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France.
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France.
FAU - Hekimian, Guillaume
AU  - Hekimian G
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France.
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France.
FAU - Luyt, Charles-Edouard
AU  - Luyt CE
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France.
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France.
FAU - Levy, Bruno
AU  - Levy B
AD  - Universite de Lorraine, CHRU de Nancy, Institut Lorrain du Coeur Et Des Vaisseaux, 
      Service de Medecine Intensive-Reanimation, U1116, FCRIN-INICRCT, Nancy, France.
FAU - Kimmoun, Antoine
AU  - Kimmoun A
AD  - Universite de Lorraine, CHRU de Nancy, Institut Lorrain du Coeur Et Des Vaisseaux, 
      Service de Medecine Intensive-Reanimation, U1116, FCRIN-INICRCT, Nancy, France.
FAU - Combes, Alain
AU  - Combes A
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France.
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France.
AD  - Sorbonne Universite, GRC 30, RESPIRE, Assistance Publique-Hopitaux de Paris 
      (APHP) Hopital Pitie-Salpetriere, Paris, France.
FAU - Schmidt, Matthieu
AU  - Schmidt M
AD  - Service de Medecine Intensive-Reanimation, Institut de Cardiologie, APHP Sorbonne 
      Universite Hopital Pitie-Salpetriere, 75013, Paris, France. 
      matthieu.schmidt@aphp.fr.
AD  - Institute of Cardiometabolism and Nutrition, Sorbonne Universite, INSERM, 
      UMRS_1166-ICAN, 75013, Paris, France. matthieu.schmidt@aphp.fr.
AD  - Sorbonne Universite, GRC 30, RESPIRE, Assistance Publique-Hopitaux de Paris 
      (APHP) Hopital Pitie-Salpetriere, Paris, France. matthieu.schmidt@aphp.fr.
AD  - Service de Medecine Intensive Reanimation, iCAN, Institute of Cardiometabolism 
      and Nutrition, Hopital de la Pitie-Salpetriere, 47, bd de l'Hopital, 75651, Paris 
      Cedex 13, France. matthieu.schmidt@aphp.fr.
LA  - eng
PT  - Journal Article
DEP - 20220407
PL  - England
TA  - Crit Care
JT  - Critical care (London, England)
JID - 9801902
SB  - IM
MH  - Adult
MH  - Child, Preschool
MH  - *Embolism, Amniotic Fluid/therapy
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - Quality of Life
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/therapy
MH  - Stroke Volume
MH  - Ventricular Function, Left
PMC - PMC8988404
OTO - NOTNLM
OT  - Amniotic fluid embolism
OT  - Cardiogenic shock
OT  - Disseminated intravascular coagulopathy
OT  - Extracorporeal membrane oxygenation
OT  - Outcomes
COIS- Pr Combes reports grants from Getinge, personal fees from Getinge, Baxter and 
      Xenios outside the submitted work. Pr Schmidt reports receiving personal fees 
      from Getinge, Drager, and Xenios, outside the submitted work. Pr Kimmoun reports 
      receiving personal feels from Aguettant outside the submitted work. No other 
      disclosures were reported.
EDAT- 2022/04/09 06:00
MHDA- 2022/04/12 06:00
PMCR- 2022/04/07
CRDT- 2022/04/08 05:28
PHST- 2021/12/14 00:00 [received]
PHST- 2022/03/23 00:00 [accepted]
PHST- 2022/04/08 05:28 [entrez]
PHST- 2022/04/09 06:00 [pubmed]
PHST- 2022/04/12 06:00 [medline]
PHST- 2022/04/07 00:00 [pmc-release]
AID - 10.1186/s13054-022-03969-3 [pii]
AID - 3969 [pii]
AID - 10.1186/s13054-022-03969-3 [doi]
PST - epublish
SO  - Crit Care. 2022 Apr 7;26(1):96. doi: 10.1186/s13054-022-03969-3.