Skip to main content
SpringerLink
Log in

Cardiac Arrest in the Pregnant Patient

  • Chapter
  • First Online:
Emergency Department Management of Obstetric Complications

Abstract

Maternal cardiac arrest complicates 1 in 12,000 pregnancies in the United States. Pregnant patients are a specific population with unique causes of cardiac arrest. The physiologic changes during pregnancy require distinct modifications during resuscitation including positioning of the patient, anticipation of a difficult airway, and early consideration of perimortem cesarean delivery (PMCD). Therapeutic hypothermia, extracorporeal membrane oxygenation (ECMO), and fibrinolysis can be considered on a case-by-case basis. The best chance for fetal survival is maternal survival, and interventions should not be withheld from the mother out of concern for the fetus.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Mhyre JM, Tsen LC, et al. Cardiac arrest during hospitalization for delivery in the United States, 1998–2011. Anesthesiology. 2014;120(4):810–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. World Health Organization. WHO Maternal mortality ratio (per 100,000 live births). 2016. http://WHO.int/healthinfo/statistics/indmaternalmortality/en. Accessed 11 June 2016.

  3. Centers for Disease Control and Prevention. Pregnancy mortality surveillance system. 2016. http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html. Accessed 6 June 2016.

  4. Rose CH, et al. Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy. Am J Obstet Gynecol. 2015;213(5):653–6.

    Article  PubMed  Google Scholar 

  5. Schneider AP, Nelson DJ, Brown DD. In hospital cardiopulmonary resuscitation: a 30 year review. J Am Board Fam Pract. 1993;6(2):91–101.

    PubMed  Google Scholar 

  6. Clark SL. Clinical expert series: amniotic fluid embolism. Obstet Gynecol. 2014;123:337–48.

    Article  PubMed  Google Scholar 

  7. Kauer K, Bhardwaj M, et al. Amniotic fluid embolism. J Am Clin Pharm. 2016;3(2):153–9.

    Google Scholar 

  8. Moore J, Baldisseri M. Amniotic fluid embolism. Crit Care Med. 2005;33(10):S279–85.

    Article  PubMed  Google Scholar 

  9. Atta E, Gardner M. Cardiopulmonary resuscitation in pregnancy. Obstet Gynecol Clin North Am. 2007;34:585–97.

    Article  PubMed  Google Scholar 

  10. Simcox LE, Ormesher E, Tower C, Green IA. Pulmonary thromboembolism in pregnancy: diagnosis and management. Breathe. 2015;11(14):282–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Anderson BS, et al. The cumulative evidence of venous thromboembolism during pregnancy and puerperium – an 11 year Danish based population-based study of 63,000 pregnancies. Acta Ostetric Gynec Scand. 1998;77:170–3.

    Article  Google Scholar 

  12. Logan JK, et al. Evidence based diagnosis and thrombolytic treatment of cardiac arrest or peri arrest due to suspected pulmonary embolism. Am J Emerg Med. 2014;32(7):789–96.

    Article  PubMed  Google Scholar 

  13. Courtney DM, et al. Pulseless electrical activity with witnessed arrest as a predictor of sudden death from massive pulmonary embolism in outpatients. Resuscitation. 2001;49:265–72.

    Article  CAS  PubMed  Google Scholar 

  14. Hernandez C, Shuler K, et al. C.A.U.S.E.: cardiac arrest ultra-sound exam—a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008;76:198–207.

    Article  PubMed  Google Scholar 

  15. Condliffe R, Elliot C, et al. Management dilemmas in acute pulmonary embolism. Thorax. 2013:1–7.

    Google Scholar 

  16. Gartman E. The use of thrombolytic therapy in pregnancy. Obstet Med. 2013;6:105–11.

    PubMed  PubMed Central  Google Scholar 

  17. Fassulo S, Maringhini G, et al. Thrombolysis for massive pulmonary embolism in pregnancy: a case report. Int J Emerg Med. 2011;4:69.

    Article  Google Scholar 

  18. Hall RJC, Young C, Sutton GC, Cambell S. Treatment of acute massive pulmonary embolism with streptokinase during labor and delivery. Br Med J. 1972;4:647–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. GD t R a, LSM R. Treatment options in massive pulmonary embolism during pregnancy; a case-report and review of literature. Thromb Res. 2009;124:1–5.

    Article  Google Scholar 

  20. Weinberg L, Kay C, et al. Successful treatment of peripartum massive pulmonary embolism with extracorporeal membrane oxygenation and catheter-directed pulmonary thrombolytic therapy. Anesthes Intensive Care. 2011;39(3):486–91.

    CAS  Google Scholar 

  21. Bataillard A, Hebrard A, et al. Extracorporeal life support for treatment of massive pulmonary embolism in pregnancy. Perfusion. 2016;31(2):169–71.

    Article  CAS  PubMed  Google Scholar 

  22. Suresh MS, Mason CL, Munnur U. Cardiopulmonary resuscitation and the parturient. Best Pract Res Clin Obstet Gynaecol. 2010;24(3):383–400.

    Article  PubMed  Google Scholar 

  23. Hawkins JL, Chang J, et al. Anesthesia-related maternal mortality in the United States: 1979–2002. Obstet Gynecol. 2011;117(1):69–74.

    Article  PubMed  Google Scholar 

  24. Hoegberg LCG, Bania TC, et al. Systematic review of the effect of intravenous lipid emulsion therapy for local anesthetic toxicity. Clin Toxicol. 2016;54(3):167–93.

    Article  CAS  Google Scholar 

  25. McDonnell MJ, Machatuta NA, Paech MJ. Acute magnesium toxicity in an obstetric patient undergoing general anaesthesia for caesarean delivery. Int J Obstet Anesth. 2010;19(2):226–31.

    Article  CAS  PubMed  Google Scholar 

  26. Vanden Hoek TL, Morrison LJ, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S829–61.

    Article  PubMed  Google Scholar 

  27. Lu JF, Nightingale CH. Magnesium sulfate in eclampsia and preeclampsia pharmacokinetic principles. Clin Pharmacokinet. 2000;38(4):305–14.

    Article  CAS  PubMed  Google Scholar 

  28. Olsen-Chen C, Seligman NS. Hypertensive emergencies in pregnancy. Crit Care Clin. 2016;32:29–41.

    Article  Google Scholar 

  29. Swartjes JM, Schutte MF, Blecker OP. Management of eclampsia: cardiopulmonary arrest resulting from magnesium sulfate overdose. Eur J Obstet Gynecol Reprod Biol. 1992;47(1):73–5.

    Article  CAS  PubMed  Google Scholar 

  30. Berg RA, et al. Part 5: adult basic life support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation. 2010;122:S685–705.

    Article  PubMed  Google Scholar 

  31. Katz VL. Perimortem cesarean delivery: its role in maternal mortality. Semin Perinatol. 2012;36(1):68–72.

    Article  PubMed  Google Scholar 

  32. Jeejeebhoy FM, Zelop CM, et al. Cardiac arrest in pregnancy: a scientific statement from the American Heart Association. Circulation. 2015;32:1747–73.

    Article  Google Scholar 

  33. Ip JK, Campbell JP, Bushby D, Yentis SM. Cardiopulmonary resuscitation in the pregnant patient: a manikin based evaluation of methods producing lateral tilt. Anaesthesia. 2013;68:694–9.

    Article  CAS  PubMed  Google Scholar 

  34. Biro P. Difficult intubation in pregnancy. Cur Op Anes. 2011;24:249–54.

    Article  Google Scholar 

  35. McClelland SH, Bogod DG, Hardman JG. Preoxygenation and apnoea in pregnancy: changes during labour and with obstetric mortality in a computational simulation. Anesthesia. 2009;64:371–7.

    Article  CAS  Google Scholar 

  36. Donnehy KC, Pian-Smith MC. Airway management of the parturient. Int Anesthesiol Clin. 2000;38(3):147–59.

    Article  Google Scholar 

  37. Katz V, Balderston K, DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol. 2005;192:1916–21.

    Article  PubMed  Google Scholar 

  38. Baghirzada L, Balki M. Maternal cardiac arrest in a tertiary care centre during 1989–2011: a case series. Can J Anesth. 2013;60(11):1077–84.

    Article  PubMed  Google Scholar 

  39. Benson MD, Padovano A, Bourjelly G, Zhou Y. Maternal collapse: challenging the four-minute rule. EBioMedicine. 2016;6:253–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Einav S, Kaufman N, Sela HY. Maternal cardiac arrest and perimortem caesarean delivery: evidence or expert-based? Resuscitation. 2012;83(10):1191–200.

    Article  PubMed  Google Scholar 

  41. Parry R, et al. Perimortem caesarean section. Emerg Med J. 2016;33:224–9.

    Article  PubMed  Google Scholar 

  42. Yildirim C, Goksu S, Kocoglu H, et al. Perimortem cesarean delivery following severe maternal penetrating injury. Yonsei Med J. 2004;45:561–3.

    Article  PubMed  Google Scholar 

  43. Benson DW, Williams GR, Spencer FC, Yates AJ. The use of hypothermia after cardiac arrest. Anesth Analg. 1959;38:423–8.

    Article  CAS  PubMed  Google Scholar 

  44. Oguagyo K, Oyeteyo O, Stewart D, Costa S, Jones R. Successful use of therapeutic hypothermia in a pregnant patient. Tex Heart Inst J. 2015;42(4):367–71.

    Article  Google Scholar 

  45. Chauhan A, Musunuru H, et al. The use of therapeutic hypothermia after cardiac arrest in a pregnant patient. Ann Emerg Med. 2012;60(6):786–9.

    Article  PubMed  Google Scholar 

  46. Scirica BM. Therapeutic hypothermia following arrest. Circulation. 2013;127:244–50.

    Article  PubMed  Google Scholar 

  47. Agerstrand C, Abrams D, et al. Extracorporeal membrane oxygenation for cardiopulmonary failure during pregnancy and postpartum. Ann Thorac Surg. 2016;102(3):774–9.

    Article  PubMed  Google Scholar 

  48. Moore S, Dietl CA, Coleman DM. Extracorporeal life support during pregnancy. J Thorac Cardiovasc Surg. 2016;151(4):1154–60.

    Article  PubMed  Google Scholar 

  49. Leeper RW, Vladis M, Arntfield R, Guo LR. Extracorporeal membrane oxygenation in the acute treatment of cardiovascular collapse immediately post-partum. Interact Cardiovasc Thorac Surg. 2013;17(5):898–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, MedStar Southern Maryland Hospital, 7503 Surratts Road, Clinton, MD, 20735, USA

    Jessica Palmer M.D.

  2. Department of Emergency Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, 3800 Reservoir Road, NW, Washington, DC, 20007, USA

    Marianne Wallis M.D. & Joelle Borhart M.D.

Authors
  1. Jessica Palmer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marianne Wallis M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joelle Borhart M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica Palmer M.D. .

Editor information

Editors and Affiliations

  1. MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA

    Joelle Borhart

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Palmer, J., Wallis, M., Borhart, J. (2017). Cardiac Arrest in the Pregnant Patient. In: Borhart, J. (eds) Emergency Department Management of Obstetric Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-54410-6_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-54410-6_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54409-0

  • Online ISBN: 978-3-319-54410-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation