Cardiac arrest in pregnancy

Causes of cardiac arrest in pregnancy:

-Amniotic Fluid Embolism

-Acute anaphylaxis

-Massive obstetric hemorrhage

-Magnesium overdose, toxicity

-Cardiac patients with fixed cardiac output lesion

-Trauma

-Anesthesia related: catastrophic airway events, total spinal

The usual drugs and doses recommended in ACLS algorithms should be used in parturients.

No drugs should be avoided, no dose changed in order to avoid potential adverse effects on neonate or fetus.

The rescuer should place their hands 1-2 cm higher on the sternum of a woman at term to obtain better cardiac output with compression.

Left Uterine displacement is needed. A liter of maternal blood can be mobilized from venous system to cardiac output

Aorto-caval compression by the gravid uterus profoundly decreases venous return that will reduce cardiac output further during the low cardiac output state produced by closed chest compression

Even with perfect adherence to ACLS algorithms, it is unlikely to resuscitate the patient unless there is adequate displacement of the uterus.

The 4 minute rule

There seems to be lack of awareness of the benefits of delivering the fetus when appropriately performed ACLS has failed to restore circulation whithin 4 minutes.

By delivering the baby, there is immediate relief of aorto-caval compression, improved venous return, improved pulmonary mechanism, and decreased oxygen demands.

C/section should be performed in the patient’s room or where the cardiac arrest occurs.

When a patient is in cardiac arrest, transferring a patient undergoing ACLS, chest compression is logistically challenging, time consuming, and will almost certainly result in interruption of chest compression and monitoring, and decreases the maternal and fetal survival.

Once the fetus has been delivered, the remainder of the surgical procedure is not so urgent, the patient can be transferred to the OR for abdominal wound closure