Cardiac arrest in pregnancy: Difference between revisions
m (Mholtz moved page Cardiac Arrest in Pregnancy to Cardiac arrest in pregnancy) |
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
''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== | ==Diagnosis== | ||
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==Management== | ==Management== | ||
*Standard ACLS management | *Standard [[ACLS]] management | ||
**Early defibrillation - use standard energy levels (safe for fetus in maternal arrest) | **Early [[defibrillation]] - use standard energy levels (safe for fetus in maternal arrest) | ||
***Anterior/Posterior pad placement is preferred | ***Anterior/Posterior pad placement is preferred | ||
***May use AP pads to pace as well | ***May use AP pads to pace as well | ||
**Give typical adult ACLS drugs/dosages | **Give typical adult [[ACLS]] drugs/dosages | ||
**Aiway management / Ventilate with 100% FiO2 | **Aiway management / Ventilate with 100% FiO2 | ||
**Monitor EtCO2 | **Monitor EtCO2 | ||
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===Maternal Modifications=== | ===Maternal Modifications=== | ||
*Manual left uterine displacement | *Manual left uterine displacement | ||
**Displaces uterus to | **Displaces uterus to patient'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 ceiling''' and '''leftwards''' | **Put hands on left side of gravid abdomen, and '''pull upwards towards ceiling''' and '''leftwards''' | ||
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*Anticipate difficult airway with high risk of aspiration | *Anticipate difficult airway with high risk of aspiration | ||
*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> | *[[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> | ||
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==References== | ==References== | ||
<References/> | <References/> | ||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
[[Category:OB/GYN]] | [[Category:OB/GYN]] | ||
Revision as of 15:03, 11 August 2015
Background
- Occurs in ~1 in 30,000 pregnancies[1]
- Key differences from non-pregnant cardiac arrest[2]:
- Need to remove uterus from IVC (by rolling pt to side or manual lifting of uterus)
- Do not obtain venous access below the diaphragm
- Secure airway immediately
- Non-cardiac cause of arrest is more likely
- Perimortem C-section should be performed rapidly, and may save both fetus and mother
- Need to remove uterus from IVC (by rolling pt to side or manual lifting of uterus)
Clinical Features
- Cardiopulmonary arrest in gravid female.
Differential Diagnosis
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 patient'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[3]
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.
- ↑ Engels PT, Caddy SC, Jiwa G, Douglas Matheson J. Cardiac arrest in pregnancy and perimortem cesarean delivery: case report and discussion. CJEM. 2011 Nov;13(6):399-403.
- ↑ 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.