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Preeclampsia complicated by hepatic capsular rupture, TRALI and cardiac arrest: A Case for Extracorporeal Membrane Oxygenation
Abstract Number: F-71
Abstract Type: Case Report/Case Series
A 30-year-old healthy term parturient was admitted for induction of labor for elevated blood pressures and right upper quadrant pain. On admission her laboratory findings were significant for an elevated AST and ALT as well as a slightly decreased platelet count and a creatinine of 0.88. She underwent an uneventful CD . Several hours postpartum she was hypotensive and tachycardic. The patient returned to the OR for a D&C for suspected retained products of conception. However, ongoing bleeding occurred and a hysterectomy was performed for uterine atony. During this time, an internal jugular cordis and arterial line were placed. Pressors were initiated. After the administration of 13U of packed red blood cells, 10U of fresh frozen plasma, 6-units of platelets and 190 mL of cryoprecipitate the patient developed high peak airway pressures and hypoxemia. Nitric oxide was administered and low tidal volumes with PEEP and pressure control ventilation were instituted. The patient was placed on veno-venous (VV) ECMO despite ongoing bleeding and pressor requirements with immediate resolution of her hypoxemia. She ultimately required a total of 7750 mL of packed red blood cells and 7000 mL FFP. During resuscitation and re-exploration, the patient suffered a cardiac arrest and was quickly placed on venous-arterial-venous (VAV) ECMO. The patient continued to bleed and was found to have a decapsulated right lobe of the liver with laceration. The patient’s course was complicated by cardiac, hepatic, respiratory, and acute renal failure as well as altered mental status. She was decannulated by day six, extubated by day seven and discharged home on day 21. This is the first case to describe the use of ECMO in a patient requiring massive transfusion for peripartum hemorrhage after a cesarean delivery (CD).
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