Cardiac arrest in pregnancy: Difference between revisions
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==Background== | ==Background== | ||
*Key differences from | *Occurs in ~1 in 30,000 pregnancies<ref>McDonnell, NJ. Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery. Br J Anaesth. (2009)103(3):406-409.</ref> | ||
** | *Key differences from non-pregnant cardiac arrest: | ||
** | **Need to remove uterus from IVC | ||
**Non-cardiac cause of arrest is more likely | |||
**Perimortem C-section should be performed rapidly, and may save both fetus and mother | |||
==Clinical Features== | ==Clinical Features== | ||
*Cardiopulmonary arrest in gravid female. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
*Clinical | |||
==Management== | ==Management== | ||
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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 | ||
*[[Therapeutic hypothermia]] contraindicated if pt still intrapartum, but may be safe for postpartum cardiac arrest<ref>Song et al. Safely completed therapeutic hypothermia in postpartum cardiac arrest survivors. Am Jour Emer Med. June 2015. Volume 33, Issue 6, Pages 861.e5–861.e6.</ref> | |||
==Disposition== | ==Disposition== | ||
*Admit (if ROSC obtained) | *Admit (if ROSC obtained) | ||
==See Also== | ==See Also== | ||
Revision as of 21:25, 9 August 2015
Background
- Occurs in ~1 in 30,000 pregnancies[1]
- Key differences from non-pregnant cardiac arrest:
- Need to remove uterus from IVC
- Non-cardiac cause of arrest is more likely
- Perimortem C-section should be performed rapidly, and may save both fetus and mother
Clinical Features
- Cardiopulmonary arrest in gravid female.
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
- Clinical
Management
- Standard ACLS management
- Early defibrillation - use standard energy levels (safe for fetus in maternal arrest)
- Anterior/Posterior pad placement is preferred
- May use AP pads to pace as well
- 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
- Therapeutic hypothermia contraindicated if pt still intrapartum, but may be safe for postpartum cardiac arrest[2]
Disposition
- Admit (if ROSC obtained)
See Also
References
- ↑ McDonnell, NJ. Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery. Br J Anaesth. (2009)103(3):406-409.
- ↑ Song et al. Safely completed therapeutic hypothermia in postpartum cardiac arrest survivors. Am Jour Emer Med. June 2015. Volume 33, Issue 6, Pages 861.e5–861.e6.
- 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.