Cardiac arrest in pregnancy
Background
- Key differences from AHA ACLS for non-maternal cardiac arrest
- If no ROSC by 4 min of resuscitation, perform immediate perimortem cesarean delivery
- Goal of delivery within 5 min of starting resuscitation (1 minute to deliver)
Clinical Features
Differential Diagnosis
- DDx - BEAT CHOPS
- Bleeding / DIC
- Embolism - coronary, pulmonary, amniotic fluid
- Anesthetic complications
- Tone (uTerine aTony)
- Cardiac disease - MI, aortic dissection, cardiomyopathy
- HTN, preeclampsia, eclampsia
- Other - all typical H's and T's
- Placental abruption, placental previa
- Sepsis
Diagnosis
Management
- Standard ACLS management
- Early defibrillation - use standard energy levels (safe for fetus in maternal arrest)
- Anterior/Posterior pad placement is preferred
- Give typical adult ACLS drugs/dosages
- Aiway management / Ventilate with 100% FiO2
- Monitor EtCO2
- Ensure post-cardiac arrest care
- Early defibrillation - use standard energy levels (safe for fetus in maternal arrest)
Maternal Modifications
- Manual left uterine displacement
- Displaces uterus to pt's left, relieving aortocaval compression
- May be of concern even if < 20 wks
- Put hands on left side of gravid abdomen, and pull upwards towards ceiling and leftwards
- Downward force will worse IVC compression
- IVs above diaphragm - avoids IVC which may be compressed
- Administer fluids and blood products
- Anticipate difficult airway with high risk of aspiration
- If pt receiving IV magnesium prearrest, stop mag and give arrest dose calcium
- Continue CPR, positioning, de-fib, drugs, and fluids during and after C-section
Disposition
- Admit (if ROSC obtained)
See Also
Pregnancy (main) Perimortem cesarean delivery
References
- Lipman et Al. The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Management of Cardiac Arrest in Pregnancy. Anesth Analg 2014;118:1003–16.