Cardiopulmonary resuscitation in pregnancy cardiac arrest and perimortem cesarean delivery
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Published:
Jan 25, 2018
Keywords:
cardiac arrest, cardiopulmonary resuscitation, pregnancy, perimortem cesarean delivery.
Main Article Content
Abstract
Background: Pregnancy cardiac arrest is a rare
condition leading to a high maternal and neonatal
mortality rate. Wide ranges of etiologies of cardiac
arrest in pregnancy have been reported in the historical
literature, including postpartum hemorrhage, amniotic
fluid embolism, cardiovascular diseases and anesthetic
causes. Certain resuscitation strategies are used for
pregnancy cardiac arrest which diverge from the
normal population; they are anticipation of difficult
airway management, intravenous line approach above
the diaphragm, manual left uterine displacement,
and consideration of perimortem cesarean delivery
(PMCD) within 4 minutes if the return of spontaneous
circulation is not achieved. It has been acknowledged
that PMCD increases the chance of survival of both
the patient and the neonate since PMCD alters the
pregnancy physiology. A reduction of the uterine
volume resulting from PMCD brings about an
improvement in the blood flow back to the central
circulation by relieving the aortocaval compression;
a lessening of oxygen consumption; and an increase
in the lung expansion, thereby improving lung
compliance. The author reviewed up-to-date
guidelines for resuscitation in the event of pregnancy
cardiac arrest and PMCD in order to provide
knowledge to all readers. The author hopes that
what readers learn can save two lives, that of the
mother and her baby, in the future.
Article Details
Section
Review articles
References
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Resuscitation, Council on Cardiovascular Diseases
in the Young, and Council on Clinical Cardiology.
Cardiac arrest in pregnancy: a scientific statement
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increasing use of perimortem caesarean section due
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tertiary care centre during 1989-2011: a case series.
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delivery: were our assumptions correct? Am J Obstet
Gynecol. 2005;192:1916-21.
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caesarean delivery. Obstet Gynecol. 1986;68:571-6.
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WM. Anesthesia-related maternal mortality in the
United States: 1979-2002. Obstet Gynecol. 2011;117(1):
69-74.
10. Geffin B, Shapiro L. Sinus bradycardia and asystole
during spinal and epidural anesthesia: a report of
13 cases. J Clin Anesth. 1998;10:278-85.
11. Aronsohn J, Danzer B, Overdyk F, Roseman A.
Perimortem cesarean delivery in a pregnant patient with
goiter, preeclampsia, and morbid obesity. A A Case Rep.
2015:15;4(4):41-3.
12. Mhyre JM, Tsen LC, Einav S, Kuklina EV, Leffert
LR, Bateman BT. Cardiac arrest during hospitalization
for delivery in the United States, 1998-2011. Anesthesiology.
2014;120:810-18.
13. Janda M, Scheeren TW, Noldge-Schomburg GF.
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Clin Anaesthesiol. 2006;20:409-27.
14. Abouleish E, Rawal N, Rashad MN. The addition of
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bupivacaine for cesarean delivery: a prospective study
of 856 cases. Reg Anesth. 1991;16:137-40.
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the management of cardiac arrest in pregnancy. Anesth
Analg. 2014;118(5):1003-16.
16. Holmes S, Kirkpatrick ID, Zelop CM, Jassal DS. MRI
evaluation of maternal cardiac displacement in pregnancy:
implications for cardiopulmonary resuscitation.
Am J Obstet Gynecol. 2015;213(3):401.e1-5.
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pregnancy. In: Clark V, Van de Velde M, Fernando R,
editors. Oxford textbook of obstetric anesthesia. Oxford:
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care. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD,
Beilin Y, Mhyre JM, editors. Chestnut’s obstetric
anesthesia: principles and practice. 5th ed. Philadelphia:
Elsevier; 2014. p. 1219-42.
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Anaesthesia. 1988;43:347-9.
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airway. In: Clark V, Van de Velde M, Fernando R,
editors. Oxford textbook of obstetric anesthesia. Oxford:
Oxford University Press; 2016. p. 393-418.
21. Butwick AJ, Coleman L, Cohen SE, Riley ET, Carvalho B.
Minimum effective bolus dose of oxytocin during
elective caesarean delivery. Br J Anaesth. 2010;104:
338–43.
22. Pecher S, Williams E. Out-of-hospital cardiac arrest in
pregnancy with good neurological outcome for
mother and infant. Int J Obstet Anesth. 2017;29:81-4.
23. The American Society of Anesthesiologists Task Force
on Obstetric Anesthesia and the Society for Obstetric
Anesthesia and Perinatology. Practice guidelines for
obstetric anesthesia: an updated report by the American
Society of Anesthesiologists Task Force on Obstetric
Anesthesia and the Society for Obstetric Anesthesia and
Perinatology. Anesthesiology. 2016;124(2):270-300.
24. Capobianco G, Balata A, Mannazzu MC, Oggiano R, Pinna
Nossai L, Cherchi PL, et al. Perimortem cesarean delivery
30 minutes after a laboring patient jumped from a
fourth-floor window: baby survives and is normal at
age 4 years. Am J Obstet Gynecol. 2008;198(1):e15-6.
25. Shen HP, Chang WC, Yeh LS, Ho M. Amniotic fluid
embolism treated with emergency extracorporeal
membrane oxygenation: a case report. J Reprod Med.
2009;54:706–8.
26. Ecker JL, Solt K, Fitzsimons MG, MacGillivray TE.
Case records of the Massachusetts General Hospital. Case
40-2012. A 43-year-old woman with cardiorespiratory
arrest after a cesarean section. N Engl J Med. 2012;
367:2528–36.
27. Rittenberger JC, Kelly E, Jang D, Greer K, Heffner A.
Successful outcome utilizing hypothermia after cardiac
arrest in pregnancy: a case report. Crit Care Med.
2008;36:1354–6.
Mothers’ Lives: reviewing maternal deaths to make
motherhood safer: 2006-08. The Eighth Report on
Confidential Enquiries into Maternal Deaths in the
United Kingdom. BJOG. 2011;118(Suppl. 1):1-203.
2. Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B,
Joglar J, Mhyre JM, et.al. American Heart Association
Emergency Cardiovascular Care Committee, Council on
Cardiopulmonary, Critical Care, Perioperative and
Resuscitation, Council on Cardiovascular Diseases
in the Young, and Council on Clinical Cardiology.
Cardiac arrest in pregnancy: a scientific statement
from the American Heart Association. Circulation.
2015;132(18):1747-73.
3. Einav S, Kaufman N, Sela HY. Maternal cardiac arrest
and perimortem caesarean delivery: evidence or
expert-based? Resuscitation. 2012;83:1191-200.
4. Dijkman A, Huisman CM, Smit M, Schutte JM, Zwart
JJ, van Roosmalen JJ, et al. Cardiac arrest in pregnancy:
increasing use of perimortem caesarean section due
to emergency skills training? BJOG. 2010;117:282-7.
5. Baghirzada L, Balki M. Maternal cardiac arrest in a
tertiary care centre during 1989-2011: a case series.
Can J Anesth. 2013;60:1077–84.
6. Katz V, Balderston K, De Freest M. Perimortem cesarean
delivery: were our assumptions correct? Am J Obstet
Gynecol. 2005;192:1916-21.
7. Katz VL, Dotters DJ, Droegemueller W. Perimortem
caesarean delivery. Obstet Gynecol. 1986;68:571-6.
8. Eldridge AJ, Ford R. Perimortem caesarean deliveries.
Int J Obstet Anesth. 2016;27:46-54.
9. Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan
WM. Anesthesia-related maternal mortality in the
United States: 1979-2002. Obstet Gynecol. 2011;117(1):
69-74.
10. Geffin B, Shapiro L. Sinus bradycardia and asystole
during spinal and epidural anesthesia: a report of
13 cases. J Clin Anesth. 1998;10:278-85.
11. Aronsohn J, Danzer B, Overdyk F, Roseman A.
Perimortem cesarean delivery in a pregnant patient with
goiter, preeclampsia, and morbid obesity. A A Case Rep.
2015:15;4(4):41-3.
12. Mhyre JM, Tsen LC, Einav S, Kuklina EV, Leffert
LR, Bateman BT. Cardiac arrest during hospitalization
for delivery in the United States, 1998-2011. Anesthesiology.
2014;120:810-18.
13. Janda M, Scheeren TW, Noldge-Schomburg GF.
Management of pulmonary aspiration. Best Pract Res
Clin Anaesthesiol. 2006;20:409-27.
14. Abouleish E, Rawal N, Rashad MN. The addition of
0.2 mg subarachnoid morphine to hyperbaric
bupivacaine for cesarean delivery: a prospective study
of 856 cases. Reg Anesth. 1991;16:137-40.
15. Lipman S, Cohen S, Einav S, Jeejeebhoy F, Mhyre JM,
Morrison LJ, et.al. The Society for Obstetric
Anesthesia and Perinatology consensus statement on
the management of cardiac arrest in pregnancy. Anesth
Analg. 2014;118(5):1003-16.
16. Holmes S, Kirkpatrick ID, Zelop CM, Jassal DS. MRI
evaluation of maternal cardiac displacement in pregnancy:
implications for cardiopulmonary resuscitation.
Am J Obstet Gynecol. 2015;213(3):401.e1-5.
17. Toledano RD. Physiological changes associated with
pregnancy. In: Clark V, Van de Velde M, Fernando R,
editors. Oxford textbook of obstetric anesthesia. Oxford:
Oxford University Press; 2016. p. 31-48.
18. Pacheco L, Howell P, Sherwood ER. Trauma and critical
care. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD,
Beilin Y, Mhyre JM, editors. Chestnut’s obstetric
anesthesia: principles and practice. 5th ed. Philadelphia:
Elsevier; 2014. p. 1219-42.
19. Ree GA, Willis BA. Resuscitation in late pregnancy.
Anaesthesia. 1988;43:347-9.
20. Mushambi MC, Pandey R. Management of the difficult
airway. In: Clark V, Van de Velde M, Fernando R,
editors. Oxford textbook of obstetric anesthesia. Oxford:
Oxford University Press; 2016. p. 393-418.
21. Butwick AJ, Coleman L, Cohen SE, Riley ET, Carvalho B.
Minimum effective bolus dose of oxytocin during
elective caesarean delivery. Br J Anaesth. 2010;104:
338–43.
22. Pecher S, Williams E. Out-of-hospital cardiac arrest in
pregnancy with good neurological outcome for
mother and infant. Int J Obstet Anesth. 2017;29:81-4.
23. The American Society of Anesthesiologists Task Force
on Obstetric Anesthesia and the Society for Obstetric
Anesthesia and Perinatology. Practice guidelines for
obstetric anesthesia: an updated report by the American
Society of Anesthesiologists Task Force on Obstetric
Anesthesia and the Society for Obstetric Anesthesia and
Perinatology. Anesthesiology. 2016;124(2):270-300.
24. Capobianco G, Balata A, Mannazzu MC, Oggiano R, Pinna
Nossai L, Cherchi PL, et al. Perimortem cesarean delivery
30 minutes after a laboring patient jumped from a
fourth-floor window: baby survives and is normal at
age 4 years. Am J Obstet Gynecol. 2008;198(1):e15-6.
25. Shen HP, Chang WC, Yeh LS, Ho M. Amniotic fluid
embolism treated with emergency extracorporeal
membrane oxygenation: a case report. J Reprod Med.
2009;54:706–8.
26. Ecker JL, Solt K, Fitzsimons MG, MacGillivray TE.
Case records of the Massachusetts General Hospital. Case
40-2012. A 43-year-old woman with cardiorespiratory
arrest after a cesarean section. N Engl J Med. 2012;
367:2528–36.
27. Rittenberger JC, Kelly E, Jang D, Greer K, Heffner A.
Successful outcome utilizing hypothermia after cardiac
arrest in pregnancy: a case report. Crit Care Med.
2008;36:1354–6.