Lipid Emulsion Use During Maternal Cardiac Arrest With Suspected Amniotic Fluid Embolism Alex Hydock, MD; Kinsley Ochsner, MS3; Eric Krause, MD, Gina Hendren, MD Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas • Lipid emulsion is an established rescue therapy for local anesthetic systemic toxicity (LAST) • Emerging case reports suggest possible benefit in refractory cardiac arrest during suspected AFE • We present a case of maternal cardiac arrest with ROSC immediately following lipid emulsion administration Lipid Emulsion Use During Maternal Cardiac Arrest With Suspected Amniotic Fluid Embolism Alex Hydock, MD; Kinsley Ochsner, MS3; Eric Krause, MD, Gina Hendren, MD Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas 19-year-old G1P0 at 38 weeks undergoing induction of labor • Epidural placed (negative test dose) • Sudden seizure-like activity after IUPC placement • Emergent cesarean delivery Post-delivery cardiac arrest • ROSC after 13 minutes of ACLS Key event • ROSC obtained within 1 minute of IV lipid emulsion Post-cardiac arrest course and findings • Hemodynamic instability recurred after discontinuation of lipid emulsion • Coagulopathy→hemorrhage→bedside hysterectomy • Severe respiratory failure→placed on VV-ECMO Case Outcome: • Patient ultimately discharged with full neurologic recovery along with her baby Differential diagnosis: • LAST, Eclampsia, AFE, hypoglycemia, high neuraxial block Pre-VV-ECMO TEE: Mid-Esophageal Four Chamber view: Severe tricuspid regurgitation, RV dysfunction Discussion Diagnostic Challenge • AFE and LAST share overlapping clinical presentations, creating diagnostic uncertainty during obstetric cardiac arrest Potential Role of Lipid Emulsion • Established therapy for LAST • Increasing case reports of ROSC during suspected AFE associated arrest Proposed Mechanisms • Lipid “sink” effect • Direct ionotropic and lusitropic effects on heart • Pulmonary vasodilation improving RV dysfunction Clinical Takeaway • When maternal cardiac arrest occurs during labor with suspected AFE, lipid emulsion may represent a potentially life-saving adjunct therapy 1.Lynch, W., et al. (2017). A&ACase Reports, 8, 64–66. 2.Clark, S. L., et al. (2016). Am JObstet Gynecol, 215, 408–412.