Introduction: Amniotic fluid embolism (AFE) is a catastrophic complication of pregnancy with high mortality rate. It is an inflammatory response leading to cardiovascular collapse. We present a case of successful implementation of veno-arterial extracorporeal membrane oxygenation (VA ECMO) in a postpartum patient in hemorrhagic shock complicated by AFE and liver laceration.

Case Report: Patient is a GP1021 who presented at 39 2/7 weeks for induction of labor. During labor she went into cardiac arrest requiring CPR with ROSC. The neonate was delivered successfully via vacuum suction and episiotomy during resuscitation. TTE revealed a severely dilated right ventricle with high suspicion for AFE. Considering the risk for recurrent cardiac arrest, she was cannulated on VA ECMO. Post cannulation course was complicated by abdominal compartment syndrome and intra-abdominal hemorrhage secondary to a liver laceration likely sustained from CPR. She required massive transfusion (33 units of PRBCs), exploratory laparotomy and embolization of the right inferior phrenic and right hepatic artery. Due to the ongoing bleeding, she was not anticoagulated for 4 days. Successfully de-cannulated after a 6-day ECMO run without further complications, extubated the following day. She was discharged to inpatient rehabilitation after a 17-day admission.

Conclusion: AFE is an unpredictable complication with poor prognosis. In this case, prompt initiation of VA ECMO demonstrated to be pivotal for full recovery. Although ECMO without anticoagulation carries a risk of complications, it can be done with acceptable results. As evidenced by this case, it is imperative to promote rapid mobilization of resources through prompt recognition.