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    Peri-Arrest in Pregnancy: Diagnosis and Management

    Cardiovascular, Critical Care / Resuscitation

    Last Updated May 10, 2022
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    By Julian Marsden, Anmol Mattu

    Context

    • Incidence of cardiac arrest during pregnancy in Canada: 1:12,500 deliveries.1
    • Potential Contributing Factors (A-H)
      • Anesthetic complications: high neuraxial block, loss of airway, aspiration, respiratory depression, hypotension, local anesthetic systemic toxicity.
      • Bleeding: coagulopathy, uterine atony, placenta accreta, placental abruption, placenta previa, uterine rupture, trauma, surgical, transfusion reaction.
      • Cardiovascular: cardiomyopathy, myocardial infarction, aortic dissection, arrhythmias.
      • Drugs: anaphylaxis, overdose, error, magnesium, opioid, insulin, or oxytocin.
      • Embolic: pulmonary embolus, amniotic fluid, air.
      • Fever: sepsis.
      • General: non-obstetric causes of cardiac arrest.
      • Hypertension: preeclampsia/eclampsia/HELLP, intracranial bleed.

    Diagnostic Process

    Investigations based on potential etiology2:

    • Note: Use table as an adjunct to the AHA Guidelines when exploring causes of the peri-arrest.

    Recommended Treatment

    Treatment algorithm is based on the 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care3:

    • Women who remain comatose after resuscitation.
    • Targeted temperature management for pregnant patient is recommended and fetus should be continuously monitored for bradycardia.

    Quality Of Evidence?

    Justification

    The treatment algorithm is based on the 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Recommendations were based on expert opinion and limited data (observational or registry studies with limitations in design and execution, meta-analyses of such studies, and physiological or mechanistic studies).

    Low

    Related Information

    Reference List

    1. Balki M, Liu S, León JA, Baghirzada L. Epidemiology of Cardiac Arrest During Hospitalization for Delivery in Canada: A Nationwide Study. Anesth Analg. 2017;124(3):890-897.


    2. Helviz Y, Einav S. Maternal cardiac arrest. Curr Opin Anaesthesiol. 2019;32(3):298-306.


    3. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468.


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