scholarly journals UTILIZATION OF POINT-OF-CARE ULTRASOUND AND ROTATIONAL THROMBOELASTOMETRY TO DIAGNOSE AND MANAGE AMNIOTIC FLUID EMBOLISM PRESENTING AS POST-PARTUM HEMORRHAGE AND CARDIAC ARREST

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A849
Author(s):  
Angela Phillips ◽  
David Tierney
Keyword(s):  
Cardiac Arrest ◽  
Amniotic Fluid ◽  
Point Of Care ◽  
Post Partum ◽  
Amniotic Fluid Embolism ◽  
Point Of Care Ultrasound ◽  
Rotational Thromboelastometry ◽  
Post Partum Hemorrhage

scholarly journals Amniotic Fluid Embolism in Post Caesarean Section

2020 ◽  
Vol 4 (2) ◽  
pp. 161-166
Author(s):  
Defrin Defrin ◽  
Heri Farnas
Keyword(s):  
Cardiac Arrest ◽  
Cesarean Section ◽  
Amniotic Fluid ◽  
Pregnancy Termination ◽  
Post Partum ◽  
Amniotic Fluid Embolism ◽  
Initial Examination ◽  
Maternal Deaths ◽  
Obstetric Emergency ◽  
Cardiopulmonary System

Background: According to WHO, around 73% of maternal deaths globally are caused by direct obstetric causes. The amniotic fluid embolism is a life-threatening obstetric emergency characterized by sudden cardiopulmonary system failure and can be accompanied by Disseminated Intravascular Coagulation (DIC). The amniotic fluid embolism event usually occurs during labor and birth, but can also occur immediately in the post partum period or after pregnancy termination. About 56% of women will not survive for first 2 hours after the acute event. Amniotic fluid embolism is an unpredictable event, so that no prophylactic intervention can be carried out effectively and the handling and enforcement of a diagnosis that still debatable.Objective: To report maternal deaths due to amniotic fluid embolism post cesarean sectionMethod: Case ReportCase:  Reported case of a 30 years old woman with an initial diagnosis in emergency departement with decreased consciousness due to Severe hypoxia due to Pulmonary emboli due to Amniotic fluid emboli on P2A0L2 post Cesarean Section first day of puerperium. The patient experienced a sudden loss of consciousness accompanied by severe shortness of breath after 6 hours after cesarean section surgery in a private hospital. After initial examination and treatment by administering oxygen through the Nonrebreathing Mask, there was no improvement in the O2 saturation value and then the patient was intubated by the anesthetist. After intubation, the O2 saturation value still does not increase, then the patient suddenly experiences cardiac arrest and followed with cardiac resuscitation for 2 cycles accompanied by resuscitation drugs then the patient returns to spontaneous circulation. From the cardiology department, inotropic therapy was given and echocardiographic investigations were carried out. On echocardiographic examination, they found McConnel's sign which showed suspicios of pulmonary embolism. At the time the patient will be moved to the intensive care unit, the patient experiences a cardiac arrest for the second time, then resuscitation is performed again for 2 cycles, but it does not work and the patient is declared dead.Conclusion: Amniotic fluid embolism is an obstetric emergency condition that cannot be predicted and has a high mortality rate. Treatment is supportive to support the cardiopulmonary system and management of coagulopathy that may occur.Keywords: maternal mortality, amniotic fluid embolism 

scholarly journals Amniotic Fluid Embolism in Post Caesarean Section

2020 ◽  
Vol 4 (2) ◽  
pp. 192-197
Author(s):  
Defrin Defrin ◽  
Heri Farnas
Keyword(s):  
Cardiac Arrest ◽  
Cesarean Section ◽  
Amniotic Fluid ◽  
Pregnancy Termination ◽  
Post Partum ◽  
Amniotic Fluid Embolism ◽  
Initial Examination ◽  
Maternal Deaths ◽  
Obstetric Emergency ◽  
Cardiopulmonary System

BACKGROUND: According to WHO, around 73% of maternal deaths globally are caused by direct obstetric causes. The amniotic fluid embolism is a life-threatening obstetric emergency characterized by sudden cardiopulmonary system failure and can be accompanied by Disseminated Intravascular Coagulation (DIC). The amniotic fluid embolism event usually occurs during labor and birth, but can also occur immediately in the post partum period or after pregnancy termination. About 56% of women will not survive for first 2 hours after the acute event. Amniotic fluid embolism is an unpredictable event, so that no prophylactic intervention can be carried out effectively and the handling and enforcement of a diagnosis that still debatable.OBJECTIVE: To report maternal deaths due to amniotic fluid embolism post cesarean sectionMETHOD: Case ReportCASE:  Reported case of a 30 years old woman with an initial diagnosis in emergency departement with decreased consciousness due to Severe hypoxia due to Pulmonary emboli due to Amniotic fluid emboli on P2A0L2 post Cesarean Section first day of puerperium. The patient experienced a sudden loss of consciousness accompanied by severe shortness of breath after 6 hours after cesarean section surgery in a private hospital. After initial examination and treatment by administering oxygen through the Nonrebreathing Mask, there was no improvement in the O2 saturation value and then the patient was intubated by the anesthetist. After intubation, the O2 saturation value still does not increase, then the patient suddenly experiences cardiac arrest and followed with cardiac resuscitation for 2 cycles accompanied by resuscitation drugs then the patient returns to spontaneous circulation. From the cardiology department, inotropic therapy was given and echocardiographic investigations were carried out. On echocardiographic examination, they found McConnel's sign which showed suspicios of pulmonary embolism. At the time the patient will be moved to the intensive care unit, the patient experiences a cardiac arrest for the second time, then resuscitation is performed again for 2 cycles, but it does not work and the patient is declared dead.CONCLUSION: Amniotic fluid embolism is an obstetric emergency condition that cannot be predicted and has a high mortality rate. Treatment is supportive to support the cardiopulmonary system and management of coagulopathy that may occur.KEYWORDS: Maternal mortality, Amniotic Fluid Embolism

Rotational thromboelastometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism

2019 ◽  
Vol 38 ◽  
pp. 127-130 ◽  
Author(s):  
J.A. Loughran ◽  
T.L. Kitchen ◽  
S. Sindhakar ◽  
M. Ashraf ◽  
M. Awad ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Amniotic Fluid Embolism ◽  
Rotational Thromboelastometry ◽  
Diagnosis And Management

Abstract 421: Point of Care Ultrasound Sonography (POCUS) in Cardiac Arrest: Predicting Survivorship

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Ada Wong ◽  
Hassan Patail ◽  
Sahar Ahmad
Keyword(s):  
Cardiac Arrest ◽  
Tricuspid Valve ◽  
Prospective Observational Study ◽  
Thrombus Formation ◽  
Point Of Care ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Short Term ◽  
Flow Stasis

Introduction: Survival after in hospital (IH) cardiac arrest (CA) is at 17% suggesting that CA represents an arena of medical practice which deserves more attention. Ultrasound (US) may have a role in both intra-arrest management and peri-arrest prognosis. Very little is known about the role of ultrasound for IH CA. Hypothesis: Intra- arrest POCUS can provide prognostic value. Methods: This was a single center, prospective observational study and we included all IH CA which occurred when a provider was available to perform a standardized POCUS protocol. US and echocardiography imaging was collected during the intra- arrest period and compared with outcome measures of return of spontaneous circulation (ROSC) and survival to 24 hours post-ROSC. Results: Echocardiographic features which may reflect survivorship include cardiac standstill, right ventricle (RV) blood flow stasis, and the appearance of thrombus formation at or around the tricuspid valve. 10 of 16 (62.50%) patients with cardiac standstill alone and 1 of 3 (33.33%) RV stasis alone did not achieve ROSC. Of those that did achieve ROSC in these two groups, none of the patients survived beyond 24 hours of the CA. 11 of 19 (57.89%) patients with RV stasis in combination with cardiac standstill did not achieve ROSC, and of the remaining 8 patients that achieved ROSC, only 1 patient survived past 24 hours. The combination of cardiac standstill, RV stasis, and tricuspid valve thrombus had 2 of 3 (66.67%) patients fail to achieve ROSC, with the remaining 1 patient surviving only to 24 hours. The presence of cardiac standstill alone confers an association with death, with an odds ratio (OR) of 1.212. RV stasis plus cardiac standstill on intra-arrest POCUS confer a markedly higher OR 0.8250 in association with death. Conclusions: Our preliminary work brings to light the role of POCUS for predicting short term survivorship based on echocardiographic patient features. This may have implications for resource utilization in such events.

scholarly journals Do combined ultrasound and electrocardiogram-rhythm findings predict survival in emergency department cardiac arrest patients? The Second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED2) study

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 739-743 ◽  
Author(s):  
Nicole Beckett ◽  
Paul Atkinson ◽  
Jacqueline Fraser ◽  
Ankona Banerjee ◽  
James French ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Point Of Care ◽  
Cardiac Activity ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Electrocardiogram Ecg ◽  
Higher Sensitivity

ABSTRACTObjectivesPoint-of-care ultrasound (POCUS) is used increasingly during resuscitation. The aim of this study was to assess whether combining POCUS and electrocardiogram (ECG) rhythm findings better predicts outcomes during cardiopulmonary resuscitation in the emergency department (ED).MethodsWe completed a health records review on ED cardiac arrest patients who underwent POCUS. Primary outcome measurements included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge.ResultsPOCUS was performed on 180 patients; 45 patients (25.0%; 19.2%–31.8%) demonstrated cardiac activity on initial ECG, and 21 (11.7%; 7.7%–17.2%) had cardiac activity on initial POCUS; 47 patients (26.1%; 20.2%–33.0%) achieved ROSC, 18 (10.0%; 6.3%–15.3%) survived to admission, and 3 (1.7%; 0.3%–5.0%) survived to hospital discharge. As a predictor of failure to achieve ROSC, ECG had a sensitivity of 82.7% (95% CI 75.2%–88.7%) and a specificity of 46.8% (32.1%–61.9%). Overall, POCUS had a higher sensitivity of 96.2% (91.4%–98.8%) but a similar specificity of 34.0% (20.9%–49.3%). In patients with ECG-asystole, POCUS had a sensitivity of 98.18% (93.59%–99.78%) and a specificity of 16.00% (4.54%–36.08%). In patients with pulseless electrical activity, POCUS had a sensitivity of 86.96% (66.41%–97.22%) and a specificity of 54.55% (32.21%–75.61%). Similar patterns were seen for survival to admission and discharge. Only 0.8% (0.0–4.7%) of patients with ECG-asystole and standstill on POCUS survived to hospital discharge.ConclusionThe absence of cardiac activity on POCUS, or on both ECG and POCUS together, better predicts negative outcomes in cardiac arrest than ECG alone. No test reliably predicted survival.

scholarly journals Case report of amniotic fluid embolism coagulopathy following abortion; use of viscoelastic point-of-care analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Halley P. Crissman ◽  
Charisse Loder ◽  
Carlo Pancaro ◽  
Jason Bell
Keyword(s):  
Case Report ◽  
Amniotic Fluid ◽  
Point Of Care ◽  
Healthy Woman ◽  
Induced Abortion ◽  
Amniotic Fluid Embolism ◽  
Case Presentation ◽  
Induced Abortions ◽  
Life Threatening ◽  
Severe Coagulopathy

Abstract Background Amniotic fluid embolism (AFE) is a rare, life threatening obstetric complication, often associated with severe coagulopathy. Induced abortions are extremely safe procedures however complications including AFE can occur. Case presentation A 29-year-old previously healthy woman, gravida 1 para 0, presented for a scheduled second trimester induced abortion via dilation and evacuation at 22-weeks gestation. The case was complicated by a suspected AFE with associated profound coagulopathy. Viscoelastic point-of-care coagulation analysis was used to successfully and swiftly guide management of her coagulopathy. Conclusion AFE can occur in the setting of induced abortion. This case report suggests viscoelastic point-of-care coagulation analyzers may aid in the management of pregnancy-related coagulopathy by providing faster coagulation assessment than laboratory testing, and facilitating timely, targeted management of coagulopathy.

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