Cardiac arrest in pregnancy: Difference between revisions
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**If no ROSC by 4 min of resuscitation, perform immediate [[perimortem cesarean delivery]] | **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) | **Goal of delivery within 5 min of starting resuscitation (1 minute to deliver) | ||
==Clinical Features== | |||
==Differential Diagnosis== | |||
*DDx - '''BEAT CHOPS''' | *DDx - '''BEAT CHOPS''' | ||
**Bleeding / DIC | **Bleeding / DIC | ||
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**Sepsis | **Sepsis | ||
== | ==Diagnosis== | ||
* | |||
**Early defibrillation | |||
==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 | **Give typical adult ACLS drugs/dosages | ||
**Ventilate with 100% FiO2 | **Aiway management / Ventilate with 100% FiO2 | ||
**Monitor EtCO2 | **Monitor EtCO2 | ||
**Ensure post-cardiac arrest care | **Ensure post-cardiac arrest care | ||
==Maternal Modifications== | ===Maternal Modifications=== | ||
*Manual left uterine displacement | *Manual left uterine displacement | ||
**Displaces uterus to pt's left, relieving aortocaval compression | **Displaces uterus to pt's left, relieving aortocaval compression | ||
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*If pt receiving IV magnesium prearrest, stop mag and give arrest dose calcium | *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 | *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== | ==References== | ||
<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. | *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. | ||
[[Category:Critical Care]] | |||
[[Category:OB/GYN]] | |||
Revision as of 02:32, 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)
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.