{
    "abstract": "To describe the integration of point-of-care ultrasound (POCUS) and rotational thromboelastometry (ROTEM) in the diagnosis and management of cardiac arrest secondary to amniotic fluid embolism (AFE).\nA 29-year-old female presented for induction of labor at 39\u00a0weeks. Labor was complicated by hemorrhage and subsequent sinus tachycardia pulseless electrical activity (PEA) arrest. Intra-arrest POCUS demonstrated right ventricular dilation and hypokinesis adding to\u00a0a presumed hemorrhagic arrest etiology. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated at the bedside following the POCUS findings. ROTEM further clarified the etiology of hemorrhage as disseminated intravascular coagulation (DIC), and in combination with the POCUS findings led to a final diagnosis of amniotic fluid embolism with DIC. The patient was maintained on VA-ECMO without heparin in the setting of DIC. She had a complicated hospital course but was discharged home with her healthy child and no residual physical or neurologic deficits.\nIn the absence of more specific testing modalities the utilization of rapidly available POCUS in conjunction with ROTEM can impact clinical decision making of cardiovascular resuscitation in patients during labor and delivery by narrowing the differential between pulmonary embolism and AFE.",
    "authors": [
        {
            "affiliation": "Department of Graduate Medical Education, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, USA.",
            "firstname": "Angela N",
            "initials": "AN",
            "lastname": "Phillips"
        },
        {
            "affiliation": "Department of Critical Care, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, USA.",
            "firstname": "Lisa L",
            "initials": "LL",
            "lastname": "Kirkland"
        },
        {
            "affiliation": "Departments of Maternal Fetal Medicine and Critical Care, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, USA.",
            "firstname": "William E",
            "initials": "WE",
            "lastname": "Wagner"
        },
        {
            "affiliation": "Department of Critical Care, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, USA.",
            "firstname": "Roman",
            "initials": "R",
            "lastname": "Melamed"
        },
        {
            "affiliation": "Department of Graduate Medical Education, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN, USA.",
            "firstname": "David M",
            "initials": "DM",
            "lastname": "Tierney"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2022 the author(s), published by De Gruyter, Berlin/Boston.",
    "doi": "10.1515/crpm-2022-0009\n10.1002/ccr3.3433\n10.1016/j.ijoa.2018.09.001\n10.2152/jmi.67.207\n10.1097/aln.0000000000002596\n10.1016/j.ajem.2017.11.033\n10.1111/jth.14882\n10.1213/xaa.0000000000001349\n10.1016/j.ijoa.2011.05.004\n10.1097/ccm.0000000000004665\n10.1016/j.ajog.2016.06.037\n10.1111/aas.13006\n10.1016/j.euje.2005.06.012\n10.1007/s12630-021-02065-4\n10.1111/j.1538-7836.2010.03862.x\n10.1007/s11239-020-02237-x\n10.1016/j.ijoa.2012.09.008\n10.1111/jog.13284",
    "journal": "Case reports in perinatal medicine",
    "keywords": [
        "amniotic fluid embolism",
        "cardiac arrest",
        "disseminated intravascular coagulation",
        "labor and delivery",
        "point-of-care ultrasonography",
        "pregnancy"
    ],
    "methods": null,
    "publication_date": "2022-08-15",
    "pubmed_id": "40041232\n33363934\n30279053\n24622759\n32378610\n30762592\n29174452\n27994260\n32356929\n33185411\n21835606\n33031152\n27372270\n28983905\n16095975\n34312822\n20345721\n32728910\n23159521\n28188959",
    "results": null,
    "title": "Utilization of point-of-care ultrasound and rotational thromboelastometry (ROTEM) in the diagnosis and management of amniotic fluid embolism presenting as post-partum hemorrhage and cardiac arrest.",
    "xml": "<Element 'PubmedArticle' at 0x788505f3f380>"
}