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Intracardiac epinephrine as fetal resuscitation during ultrasound guided fetal intervention Introduction
Abstract Number: SA-36
Abstract Type: Original Research
Advances in fetal diagnostic ultrasound have enabled the use of ultrasound-guided fetal treatment for such conditions as anemia, hydrops fetalis, pleural effusion. and pericardial effusion. Anesthesiolosists are asked to provide fetal anesthesia for pain relief and immobilization of the fetus. Our standard anesthetic method is maternal intravenous administration of diazepam and fentanyl for better placental transfer. We have encountered severe fetal bradycardia during such procedures, in which fetal intracardiac epinephrine has been effective for resuscitation. The purpose of this study was to review such cases to show the success rate and complications.
After institutional review board approval, the medical and anesthesia records of fetal anesthesia were retrospectively reviewed, between 2001 to 2015. Fetal resuscitations with intracardiac epinephrine were reviewed with regard to gestational age, fetal diagnosis, procedure, timing of cardiac arrest, intracardiac drug, and long term outcome.
Severe bradycardia or cardiac arrest occurred in 7 occasions in 6 fetuses among total of 253 cases. The table shows details of 7 episodes. The trimester at the time of the procedure was 0 in the 1st, 3 in the 2nd, and 4 in the 3rd trimester. Therapeutic procedures were cordocentesis and fetal blood transfusion in 4 cases, thoracentesis and cordocentesis in 1 case, and thoracoamniotic shunt in 1 case. Cardiac arrest occurred during or right after the procedures in all cases. Intracardiac epinephrine was successful in resuscitation in 71% of the attempts. Resuscitation was difficult or unsuccessful in cases of fetal transfusion at early gestational age. 3 out of 6 babies are still alive. There was one complication, i.e., fetal pericardial effusion due to needle trauma, resulting in cardiac tamponade. The ultrasound guided drainage was successful.
There has only been one report of fetal resuscitation by intracardiac epinephrine administration in the literature. Although resuscitation was successful, the fetus died within the following 12 h in this case report. Thus our experience is the first to show the survival after intracardiac epinephrine as a means of fetal resuscitation.
It is now our practice to have fetal resuscitation drugs ready before starting the procedures on fetal hydrops, and to assess fetal heart rate during the procedure.