Refractory Hypoxemia and Resuscitation in the Setting of Catastrophic Hemorrhage From Uterine Rupture: A Case Study.

Catastrophic hemorrhage from uterine rupture is a rare but life threatening obstetric emergency. Patients often present in extremis with concurrent hemodynamic instability. The case study describes the retrieval of a critically ill patient and the challenges encountered during patient transfer and resuscitation. The patient was profoundly hypovolemic and hypoxemic and required intensive therapies such as massive transfusion and adjustments to mechanical ventilation. The case review highlights therapies relevant to the practice of critical care transport medicine including damage control resuscitation. Novel hemorrhage control techniques such as resuscitative endovascular balloon occlusion of the aorta were also considered. Finally, the case report describes complications linked to ongoing resuscitation including transfusion associated circulatory overload. The case emphasizes the utility of multidisciplinary collaboration for complex patient retrievals.