Early application of modified A-OK protocol for amniotic fluid embolism: Case series report
Year: 2025
Type: article
Study design: Case Report
Abstract: RATIONALE: Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency with high mortality, characterized by sudden cardiovascular collapse, hypoxia, and coagulopathy. Current management is primarily supportive, but emerging case reports suggest a potential benefit from a novel regimen combining atropine, ondansetron, and ketorolac (A-OK). However, due to AFE's extreme rarity, large-scale studies are lacking. PATIENT CONCERNS: Three women with suspected AFE presented with acute hemodynamic instability, hypoxia, or coagulopathy during or shortly after delivery. DIAGNOSES: AFE was clinically diagnosed based on sudden cardiovascular collapse, respiratory distress, and coagulopathy in the peripartum setting. INTERVENTIONS: A modified A-OK protocol, atropine, granisetron (replacing ondansetron), and lornoxicam (replacing ketorolac) (A-GL), was administered early alongside standard resuscitation measures. OUTCOMES: Rapid hemodynamic stabilization and improved oxygenation were observed within minutes of A-GL administration. All 3 patients survived with favorable outcomes. LESSONS: These cases suggest that early A-OK-based therapy (or its modified A-GL regimen) may improve outcomes in AFE. Further research is warranted to validate this approach and refine treatment protocols.
Source: Medicine
Authors: Shanshan He, Bo Tao
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W4415526458