One of the most compelling case reports on intralipid therapy for amniotic fluid embolism comes from Baylor-Scott White Memorial Hospital. The case involved a patient who experienced the sudden onset of amniotic fluid embolism during labor, characterized by the development of DIC during labor, subsequent cardiovascular collapse after delivering the baby, and extended resuscitation efforts with CPR for over 40 minutes without achieving the return of spontaneous circulation.
Given that the patient had an epidural with ropivacaine, the medical team considered the possibility of LAST but found it unlikely based on the dose and lack of symptoms such as tinnitus or CNS disturbances.
The team decided to administer a bolus of intralipid. Remarkably, within 30 to 90 seconds of administration, a return of spontaneous circulation was achieved, accompanied by improved right and left ventricular function on transesophageal echocardiography. After several minutes, the patient experienced another episode of cardiovascular collapse, prompting a second intralipid bolus, which again restored the return of spontaneous circulation within 30 to 60 seconds.
Over the subsequent months, the patient’s recovery was excellent, with minimal neurological deficits and full functional capacity. This dramatic improvement highlighted the potential role of intralipid therapy in reversing the effects of amniotic fluid embolism and prompted further interest in its use for this condition.
Timeline of the reported case, from DIC during labor to return of spontaneous circulation after each intralipid bolus.
