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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; 68:1541-1548. [PMID: 34312822 DOI: 10.1007/s12630-021-02065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Amniotic fluid embolism (AFE) is a rare, but often fatal condition characterized by sudden hemodynamic instability and coagulopathy occurring during labour or in the early postpartum period. As the mechanisms leading to shock and the cardiovascular effects of AFE are incompletely understood, the purpose of this case series is to describe how AFE presents on echocardiography and review limited reports in the literature. CLINICAL FEATURES We describe three cases of AFE at the Jewish General Hospital, a tertiary care centre in Montreal, Canada. All cases met the Clark diagnostic criteria, which comprise 1) sudden cardiorespiratory arrest or both hypotension and respiratory compromise, 2) disseminated intravascular coagulation, 3) clinical onset during labour or within 30 min of delivery of the placenta, and 4) absence of fever. Two patients had a cardiac arrest and the third developed significant hypotension and hypoxia. In all patients, point-of-care echocardiography at the time of shock revealed signs of right ventricular failure including a D-shaped septum, acute pulmonary hypertension, and right ventricular systolic dysfunction. CONCLUSION This case series and literature review of AFE emphasizes the importance of echocardiography in elucidating the etiology of maternal shock. The presence of right ventricular failure may be considered an important criterion to diagnose AFE.
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Affiliation(s)
- Camille Simard
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Stephen Yang
- Division of Critical Care, Department of Medicine, Jewish General Hospital, McGill University, 3755 ch. de la Côte-Sainte-Catherine Rd, Suite H-364.1, Montreal, QC, H3T 1E2, Canada
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maral Koolian
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Roberta Shear
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lawrence Rudski
- Azrieli Heart Center, Jewish General Hospital, Montreal, QC, Canada
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jed Lipes
- Division of Critical Care, Department of Medicine, Jewish General Hospital, McGill University, 3755 ch. de la Côte-Sainte-Catherine Rd, Suite H-364.1, Montreal, QC, H3T 1E2, Canada.
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Denault AY, Roberts M, Cios T, Malhotra A, Paquin SC, Tan S, Cavayas YA, Desjardins G, Klick J. Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach. Anesth Analg 2021; 133:630-647. [PMID: 34086617 DOI: 10.1213/ane.0000000000005537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
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Affiliation(s)
- André Y Denault
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Theodore Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Anita Malhotra
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Sarto C Paquin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Stéphanie Tan
- Department of Radiology, Montreal Heart Institute, Université de Montréal
| | - Yiorgos Alexandros Cavayas
- Department of Medicine and Intensive Care Unit, Montreal Sacré-Coeur Hospital and Department of Medicine and Intensive Care Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Atallah D, Abou Zeid H, Moubarak M, Moussa M, Nassif N, Jebara V. "You only live twice": multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report. BMC Pregnancy Childbirth 2020; 20:135. [PMID: 32111175 PMCID: PMC7048027 DOI: 10.1186/s12884-020-2817-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/18/2020] [Indexed: 01/12/2023] Open
Abstract
Background Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient’s death. Conclusion This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.
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Affiliation(s)
- David Atallah
- Saint Joseph University, Beirut, Lebanon. .,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, P.O. Box: 116-5137, Beirut, Lebanon.
| | - Hicham Abou Zeid
- Saint Joseph University, Beirut, Lebanon.,Department of Anesthesiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Malak Moubarak
- Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, P.O. Box: 116-5137, Beirut, Lebanon
| | - Maya Moussa
- Saint Joseph University, Beirut, Lebanon.,Department of Anesthesiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Nadine Nassif
- Saint Joseph University, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, P.O. Box: 116-5137, Beirut, Lebanon
| | - Victor Jebara
- Saint Joseph University, Beirut, Lebanon.,Department of Cardiovascular Surgery, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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