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Case Report
Treatment of amniotic fluid embolism using a modified advanced cardiac life support pulseless electrical activity protocol
1 Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
2 Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
3 Lankenau Medical Center, Wynnewood, Pennsylvania, USA
4 Clinical Professor, Department of Anesthesiology & Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Address correspondence to:
Dmitri Chamchad
MD, Lankenau Institute for Medical Research, 100 E Lancaster Ave, Wynnewood, PA 19096,
USA
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Article ID: 100209Z08DC2025
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How to cite this article
Chamchad D, Lebedev M, Langan E, Horrow J. Treatment of amniotic fluid embolism using a modified advanced cardiac life support pulseless electrical activity protocol. J Case Rep Images Obstet Gynecol 2025;11(2):1–4.ABSTRACT
Introduction: Several treatment paradigms exist to resuscitate patients who suffer amniotic fluid embolism (AFE). None has achieved universal acclaim.
Case Report: A 34-year-old G2P1 woman with 38-week twin gestation underwent primary cesarean section with combined spinal-epidural anesthesia. Shortly after delivery of twin A, maternal blood pressure (BP) was 49/22 mmHg, SpO2 60%; she lost consciousness. During 12 minutes of resuscitation, she received gentle mask ventilation, hydrocortisone, diphenhydramine, ondansetron, and two doses of epinephrine. Vital signs stabilized. This approach minimized pulmonary vascular resistance by (1) using epinephrine; (2) avoiding intubation, positive end-expiratory pressure (PEEP), and fluid resuscitation; (3) blocking serotonin with ondansetron; and (4) blocking thromboxane with hydrocortisone, then ketorolac. These interventions decrease pulmonary edema and congestion.
Conclusion: We report a case of successful resuscitation from AFE that avoided intubation and PEEP. Successful AFE treatment should focus on keeping pulmonary vascular resistance low.
Keywords: Amniotic fluid embolism, Pulmonary capillary leak, Pulmonary hypertension, Pulseless electrical activity
SUPPORTING INFORMATION
Author Contributions
Dmitri Chamchad - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Maria Lebedev - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Erin Langan - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Jay Horrow - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Dmitri Chamchad et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
