Hypoxic cardiac arrest in pregnancy due to pulmonary haemorrhage

Abstract

A 23-year-old woman developed massive pulmonary haemorrhage in the 19th week of pregnancy. Essential invasive ventilation was seriously impaired by the mechanical properties of the blood-filled lungs. Consecutive severe respiratory failure (pO2 10 mm Hg, pCO2 320 mm Hg, pH 6.73) induced a cardiac arrest. Bronchoscopy could not identify the source of bleeding. During 45 min of cardiopulmonary resuscitation, venovenous extracorporeal membrane oxygenation (ECMO) was installed. Subsequently, neither a high-resolution CT (HRCT) scan nor pulmonary angiography could identify the origin of the haemorrhage. Finally, the excessive pulmonary bleeding was controlled by placing an endobronchial blocker in the middle lobe bronchus. However, pulmonary haemorrhage reoccurred and this time HRCT revealed an isolated bronchiectasis in the middle lobe. Based on this finding, surgical lobectomy was performed. The patient recovered fully without any neurological sequelae. A solitary bronchiectasis has not previously been described as a cause of massive pulmonary haemorrhage in pregnancy. Copyright 2012 BMJ Publishing Group. All rights reserved.