Early application of modified A-OK protocol for amniotic fluid embolism: Case series 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.
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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