{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T08:51:04Z","timestamp":1781599864947,"version":"3.54.5"},"reference-count":20,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"j_crpm-2022-0009_abs_001\"><jats:title>Objectives<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec id=\"j_crpm-2022-0009_abs_002\"><jats:title>Case presentation<\/jats:title><jats:p>A 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.<\/jats:p><\/jats:sec><jats:sec id=\"j_crpm-2022-0009_abs_003\"><jats:title>Conclusions<\/jats:title><jats:p>In 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.<\/jats:p><\/jats:sec>","DOI":"10.1515\/crpm-2022-0009","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T18:36:07Z","timestamp":1660588567000},"source":"Crossref","is-referenced-by-count":2,"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"],"prefix":"10.1515","volume":"11","author":[{"given":"Angela N.","family":"Phillips","sequence":"first","affiliation":[{"name":"Department of Graduate Medical Education , Abbott Northwestern Hospital, Allina Health , Minneapolis , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa L.","family":"Kirkland","sequence":"additional","affiliation":[{"name":"Department of Critical Care , Abbott Northwestern Hospital, Allina Health , Minneapolis , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Departments of Maternal Fetal Medicine and Critical Care , Abbott Northwestern Hospital, Allina Health , Minneapolis , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Melamed","sequence":"additional","affiliation":[{"name":"Department of Critical Care , Abbott Northwestern Hospital, Allina Health , Minneapolis , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4202-1101","authenticated-orcid":false,"given":"David M.","family":"Tierney","sequence":"additional","affiliation":[{"name":"Department of Graduate Medical Education , Abbott Northwestern Hospital, Allina Health , Minneapolis , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2022,8,15]]},"reference":[{"key":"2023033120062531207_j_crpm-2022-0009_ref_001","doi-asserted-by":"crossref","unstructured":"Sitaula, S, Das, D, Sitaula, S, Chhetry, M. Amniotic fluid embolism: a\u00a0rare cause of maternal collapse-a case report. Clin Case Rep 2020;8:3359\u201361. https:\/\/doi.org\/10.1002\/ccr3.3433.","DOI":"10.22541\/au.159986327.73387396"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_002","doi-asserted-by":"crossref","unstructured":"Loughran, JA, Kitchen, TL, Sindhakar, S, Ashraf, M, Awad, M, Kealaher, EJ. Rotational thromboelastometry (ROTEM\u00ae)-guided diagnosis and management of amniotic fluid embolism. Int J Obstet Anesth 2019;38:127\u201330. https:\/\/doi.org\/10.1016\/j.ijoa.2018.09.001.","DOI":"10.1016\/j.ijoa.2018.09.001"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_003","doi-asserted-by":"crossref","unstructured":"Rath, WH, Hoferr, S, Sinicina, I. Amniotic fluid embolism: an interdisciplinary challenge: epidemiology, diagnosis and treatment. Dtsch Arztebl Int 2014;11:126\u201332.","DOI":"10.3238\/arztebl.2014.0126"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_004","doi-asserted-by":"crossref","unstructured":"Ishikawa, Y, Hari, Y, Murakami, C, Honda, Y, Oyama, T, Kawanishi, R, et al.. Early diagnosis of the cardiopulmonary collapse type of amniotic fluid embolism with obstetrical disseminated intravascular coagulation during elective cesarean section: a\u00a0case report. J Med Invest 2020;67:207\u201310. https:\/\/doi.org\/10.2152\/jmi.67.207.","DOI":"10.2152\/jmi.67.207"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_005","doi-asserted-by":"crossref","unstructured":"Jatin, DD, Mary, MC. Amniotic fluid embolism. Cont Educ Anaesth Crit Care Pain 2007;7:152\u20136.","DOI":"10.1093\/bjaceaccp\/mkm031"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_006","doi-asserted-by":"crossref","unstructured":"Acker, LC, Jones, RC, Rasouli, MR, Bronshteyn, YS. Focused cardiac ultrasound during amniotic fluid embolism. Anesthesiology 2019;130:1032\u20133. https:\/\/doi.org\/10.1097\/aln.0000000000002596.","DOI":"10.1097\/ALN.0000000000002596"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_007","doi-asserted-by":"crossref","unstructured":"Dwyer, KH, Rempell, JS, Stone, MB. Diagnosing centrally located\u00a0pulmonary embolisms in the emergency department using point-of-care ultrasound. Am J Emerg Med 2018;36:1145\u201350. https:\/\/doi.org\/10.1016\/j.ajem.2017.11.033.","DOI":"10.1016\/j.ajem.2017.11.033"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_008","doi-asserted-by":"crossref","unstructured":"Hurwich, M, Zimmer, D, Guerra, E, Evans, E, Shire, T, Abernathy, M, et al.. A case of successful thromboelastographic guided resuscitation after postpartum hemorrhage and cardiac arrest. J\u00a0Extra Corpor Technol 2016;48:194\u20137.","DOI":"10.1051\/ject\/201648194"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_009","doi-asserted-by":"crossref","unstructured":"Amgalan, A, Allen, T, Othman, M, Ahmadzia, HK. Systematic review of viscoelastic testing (TEG\/ROTEM) in obstetrics and recommendations from the women\u2019s SSC of the ISTH. J Thromb Haemostasis 2020;18:1813\u201338. https:\/\/doi.org\/10.1111\/jth.14882.","DOI":"10.1111\/jth.14882"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_010","doi-asserted-by":"crossref","unstructured":"Chiao, SS, Sheeran, JS. Extracorporeal membrane oxygenation therapy after amniotic fluid embolism with undetectable ROTEM FIBTEM activity: a case report. A A Pract 2020;14:e01349. https:\/\/doi.org\/10.1213\/xaa.0000000000001349.","DOI":"10.1213\/XAA.0000000000001349"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_011","doi-asserted-by":"crossref","unstructured":"Armstrong, S, Fernando, R, Ashpole, K, Simons, R, Columb, M. Assessment of coagulation in the obstetric population using ROTEM\u00ae thromboelastometry. Int J Obstet Anesth 2011;20:293\u20138. https:\/\/doi.org\/10.1016\/j.ijoa.2011.05.004.","DOI":"10.1016\/j.ijoa.2011.05.004"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_012","doi-asserted-by":"crossref","unstructured":"Oda, T, Tamura, N, Ide, R, Itoh, T, Horikoshi, Y, Matsumoto, M, et al.. Consumptive coagulopathy involving amniotic fluid embolism: the importance of earlier assessments for interventions in critical care. Crit Care Med 2020;48:e1251\u201359. https:\/\/doi.org\/10.1097\/ccm.0000000000004665.","DOI":"10.1097\/CCM.0000000000004665"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_013","doi-asserted-by":"crossref","unstructured":"Clark, SL, Romero, R, Dildy, GA, Callaghan, WM, Smiley, RM, Bracey, AW, et al.. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am J Obstet Gynecol 2016;215:408\u201312. https:\/\/doi.org\/10.1016\/j.ajog.2016.06.037.","DOI":"10.1016\/j.ajog.2016.06.037"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_014","doi-asserted-by":"crossref","unstructured":"Maack, KH, Munk, K, Dahl, K, J\u00f8rgensen, HH, Christiansen, A, Helmig, RB. Right heart masses demonstrated by echocardiography in a patient with amniotic fluid embolism during labour. Acta Anaesthesiol Scand 2018;62:134\u20137. https:\/\/doi.org\/10.1111\/aas.13006.","DOI":"10.1111\/aas.13006"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_015","doi-asserted-by":"crossref","unstructured":"Saad, A, El-Husseini, N, Nader, GA, Gharzuddine, W. Echocardiographically detected mass \u201cin transit\u201d in early amniotic fluid embolism. Eur J Echocardiogr 2006;7:332\u20135. https:\/\/doi.org\/10.1016\/j.euje.2005.06.012.","DOI":"10.1016\/j.euje.2005.06.012"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_016","doi-asserted-by":"crossref","unstructured":"Simard, C, Yang, S, Koolian, M, Shear, R, Rudski, L, Lipes, J. The role of echocardiography in amniotic fluid embolism: a case series and review of the literature. Can J Anaesth 2021;68:1541\u20138. https:\/\/doi.org\/10.1007\/s12630-021-02065-4.","DOI":"10.1007\/s12630-021-02065-4"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_017","doi-asserted-by":"crossref","unstructured":"Leitner, JM, Jilma, B, Spiel, AO, Sterz, F, Laggner, AN, Janata, KM. Massive pulmonary embolism leading to cardiac arrest is associated with consumptive coagulopathy presenting as disseminated intravascular coagulation. J Thromb Haemostasis 2010;8:1477\u201382. https:\/\/doi.org\/10.1111\/j.1538-7836.2010.03862.x.","DOI":"10.1111\/j.1538-7836.2010.03862.x"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_018","doi-asserted-by":"crossref","unstructured":"Fudaba, M, Tachibana, D, Misugi, T, Nakano, A, Koyama, M. Excessive fibrinolysis detected with thromboelastography in\u00a0a\u00a0case of amniotic fluid embolism: fibrinolysis may precede\u00a0coagulopathy. J Thromb Thrombolysis 2021;51:818\u201320. https:\/\/doi.org\/10.1007\/s11239-020-02237-x.","DOI":"10.1007\/s11239-020-02237-x"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_019","doi-asserted-by":"crossref","unstructured":"Collins, NF, Bloor, M, McDonnell, NJ. Hyperfibrinolysis diagnosed by rotational thromboelastometry in a case of suspected amniotic fluid embolism. Int J Obstet Anesth 2013;22:71\u20136. https:\/\/doi.org\/10.1016\/j.ijoa.2012.09.008.","DOI":"10.1016\/j.ijoa.2012.09.008"},{"key":"2023033120062531207_j_crpm-2022-0009_ref_020","doi-asserted-by":"crossref","unstructured":"Tamura, N, Farhana, M, Oda, T, Itoh, H, Kanayama, N. Amniotic fluid embolism: pathophysiology from the perspective of pathology. J\u00a0Obstet Gynaecol Res 2017;43:627\u201332. https:\/\/doi.org\/10.1111\/jog.13284.","DOI":"10.1111\/jog.13284"}],"container-title":["Case Reports in Perinatal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/crpm-2022-0009\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/crpm-2022-0009\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,25]],"date-time":"2023-11-25T20:16:03Z","timestamp":1700943363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/crpm-2022-0009\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,1]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,8,19]]},"published-print":{"date-parts":[[2022,1,27]]}},"alternative-id":["10.1515\/crpm-2022-0009"],"URL":"https:\/\/doi.org\/10.1515\/crpm-2022-0009","relation":{},"ISSN":["2192-8959"],"issn-type":[{"value":"2192-8959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,1]]},"article-number":"20220009"}}