Cardiac arrest in pregnancy: Difference between revisions
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**Displaces uterus to pt's left, relieving aortocaval compression | **Displaces uterus to pt's left, relieving aortocaval compression | ||
**May be of concern even if < 20 wks | **May be of concern even if < 20 wks | ||
**Put hands on left side of gravid abdomen, and '''pull upwards towards | **Put hands on left side of gravid abdomen, and '''pull upwards towards ceiling''' and '''leftwards''' | ||
**Downward force will worse IVC compression | **Downward force will worse IVC compression | ||
*IVs above diaphragm - avoids IVC which may be compressed | *IVs above diaphragm - avoids IVC which may be compressed | ||
Revision as of 02:06, 9 August 2015
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)
- 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
Interventions
- In keeping with regular ACLS algorithms
- Early defibrillation, same energy dosages; safe for fetus in maternal arrest
- Give typical adult ACLS drugs/dosages
- Ventilate with 100% FiO2
- Monitor EtCO2
- Ensure post-cardiac arrest care
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
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.