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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

28-10-2022 | Echocardiography | Review Article/Brief Review

Echocardiography findings in amniotic fluid embolism: a systematic review of the literature

Authors: Daniel Wiseman, MD, Camille Simard, MD, Stephen S. Yang, MD, MSc, Maral Koolian, MD, MSc, Haim A. Abenhaim, MD, MPH, Jed Lipes, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 1/2023

Abstract

Purpose

Amniotic fluid embolism (AFE) is a leading cause of obstetrical cardiac arrest and maternal morbidity. The pathogenesis of hemodynamic collapse is thought to be from right ventricular (RV) failure; however, there is a paucity of data documenting echocardiography findings in this population. We undertook a systematic review of the literature to evaluate the echocardiography findings in patients with AFE.

Sources

We retrieved all case reports and case series reporting AFE in Embase and MEDLINE from inception to 20 November 2021. Studies reporting AFE diagnosed by fulfilling at least one of three different proposed AFE criteria and echocardiography findings during hospitalization were included. Patient and echocardiographic data were retrieved, and univariate logistic regression analysis was performed for outcomes of interest. Bias was assessed using the Joanna Briggs Institute clinical appraisal tool for case series.

Principal findings

Eighty publications reporting on 84 patients were included in the final review. Fifty-five out of 82 patients with data (67%) showed RV dysfunction, including 11/82 (13%) with biventricular dysfunction; 14/82 (17%) had normal systolic function. No data on RV or left ventricular function were reported for two patients. The presence of RV dysfunction on echocardiography was associated with cardiac arrest (odds ratio [OR], 3.66; 95% confidence interval [CI], 1.39 to 9.67; P = 0.009), and a composite risk of cardiac arrest, maternal death or use of extracorporeal membrane oxygenation (OR, 3.86; 95% CI, 1.43 to 10.4; P = 0.007). A low risk of bias was observed in 15/84 (18%) cases.

Conclusions

Right ventricular dysfunction on echocardiography is a common finding in AFE and is associated with a high risk of cardiac arrest. The finding of RV dysfunction on echocardiography may help diagnose AFE and help triage the highest risk patients with AFE.

Study registration

PROSPERO (CRD42021271323); registered 1 September 2021.

Available only for authorised users

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Title: Echocardiography findings in amniotic fluid embolism: a systematic review of the literature
Authors: Daniel Wiseman, MD
Camille Simard, MD
Stephen S. Yang, MD, MSc
Maral Koolian, MD, MSc
Haim A. Abenhaim, MD, MPH
Jed Lipes, MD
Publication date: 28-10-2022
Publisher: Springer International Publishing
Keywords: Echocardiography
Disseminated Intravascular Coagulation
Echocardiography
Amniotic Fluid Embolism
ECMO
ECMO
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 1/2023
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02343-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Echocardiography findings in amniotic fluid embolism: a systematic review of the literature

Abstract

Purpose

Sources

Principal findings

Conclusions

Study registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Sources

Principal findings

Conclusions

Study registration

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