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BMJ Case Reports 2014; doi:10.1136/bcr-2014-204672
  • CASE REPORT

Survival after an amniotic fluid embolism following the use of sodium bicarbonate

  1. Stan Tay2
  1. 1Department of Anaesthesia, Townsville Hospital, Douglas, Queensland, Australia
  2. 2Department of Anaesthesia, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
  1. Correspondence to Dr Stan Tay, stanley.tay{at}nt.gov.au
  • Accepted 16 May 2014
  • Published 30 May 2014

Summary

Amniotic fluid embolism (AFE) is a rare and potentially fatal complication of pregnancy. In this case report, we highlight the successful use of sodium bicarbonate in a patient with an AFE. We present a case of a 38-year-old mother admitted for an elective caesarean section. Following the delivery of her baby, the mother suffered a cardiac arrest. Following a protracted resuscitation, transoesophageal echocardiography demonstrated evidence of acute pulmonary hypertension, with an empty left ventricle and an over-distended right ventricle. In view of these findings and no improvement noted from on-going resuscitation, sodium bicarbonate was infused as a pulmonary vasodilator. Almost instantaneous return of spontaneous circulation was noted, with normalisation of cardiac parameters. We propose that in patients suspected with AFE and who have been unresponsive to advance cardiac life support measures, and where right ventricular failure is present with acidosis and/or hypercarbia, the use of sodium bicarbonate should be considered.

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