Advertisement

Neurocritical Care

, Volume 13, Issue 2, pp 239–242 | Cite as

A Report of Fetal Demise During Therapeutic Hypothermia After Cardiac Arrest

  • Elissa Fory Wible
  • Joseph S. Kass
  • George A. Lopez
Practical Pearl

Abstract

Background

Therapeutic hypothermia is becoming the standard-of-care for coma following out-of-hospital cardiac arrest. Pregnancy has been considered a contraindication for therapeutic hypothermia.

Methods

Case report.

Results

A 44-year-old woman presented after a witnessed out-of-hospital ventricular fibrillation cardiac arrest. She remained comatose upon hospital admission and was treated with induced hypothermia via surface cooling pads. An intrauterine pregnancy of 20 weeks gestation was discovered on admission. One day after admission, a stillborn fetus was spontaneously delivered. The patient made a good neurologic recovery and now lives at home with her family.

Conclusion

During pregnancy, beneficence toward the pregnant woman must be the primary ethical guideline in emergent, life-threatening situations. Pregnancy should not be a contraindication to therapeutic hypothermia following cardiac arrest.

Keywords

Cardiopulmonary resuscitation Sudden cardiac death Hypoxic-ischemic encephalopathy Induced hypothermia Pregnancy Stillbirth Fetal demise 

References

  1. 1.
    Heron M. Deaths: leading causes for 2004. Natl Vital Stat Rep. 2007;56:1–95.PubMedGoogle Scholar
  2. 2.
    Turakhia M, Tseng ZH. Sudden cardiac death: epidemiology, mechanisms, and therapy. Curr Probl Cardiol. 2007;32:501–46.CrossRefPubMedGoogle Scholar
  3. 3.
    Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–56.Google Scholar
  4. 4.
    Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–63.CrossRefPubMedGoogle Scholar
  5. 5.
    2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112:IV1–203.Google Scholar
  6. 6.
    Bernard SA, Jones BM, Horne MK. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Ann Emerg Med. 1997;30:146–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Zeiner A, Holzer M, Sterz F, et al. Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group. Stroke. 2000;31:86–94.PubMedGoogle Scholar
  8. 8.
    McCullough LB, Coverdale JH, Chervenak FA. Preventive ethics for including women of childbearing potential in clinical trials. Am J Obstet Gynecol. 2006;194:1221–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation. 2005;67(Suppl 1):S39–86.CrossRefPubMedGoogle Scholar
  10. 10.
    Nolan JP, Morley PT, Hoek TL, Hickey RW. Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation. 2003;57:231–5.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    Li JM, Nguyen C, Joglar JA, Hamdan MH, Page RL. Frequency and outcome of arrhythmias complicating admission during pregnancy: experience from a high-volume and ethnically-diverse obstetric service. Clin Cardiol. 2008;31:538–41.CrossRefPubMedGoogle Scholar
  13. 13.
    Nelissen EC, de Zwaan C, Marcus MA, Nijhuis JG. Maternal cardiac arrest in early pregnancy. Int J Obstet Anesth. 2009;18:60–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Atta E, Gardner M. Cardiopulmonary resuscitation in pregnancy. Obstet Gynecol Clin N Am. 2007;34:585–97, xiii.Google Scholar
  15. 15.
    Mallampalli A, Guy E. Cardiac arrest in pregnancy and somatic support after brain death. Crit Care Med. 2005;33:S325–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Ayorinde BT, Scudamore I, Buggy DJ. Anaesthetic management of a pregnant patient in a persistent vegetative state. Br J Anaesth. 2000;85:479–81.PubMedGoogle Scholar
  17. 17.
    Hill LM, Parker D, O’Neill BP. Management of maternal vegetative state during pregnancy. Mayo Clin Proc. 1985;60:469–72.PubMedGoogle Scholar
  18. 18.
    Webb GW, Huddleston JF. Management of the pregnant woman who sustains severe brain damage. Clin Perinatol. 1996;23:453–64.PubMedGoogle Scholar
  19. 19.
    Bush MC, Nagy S, Berkowitz RL, Gaddipati S. Pregnancy in a persistent vegetative state: case report, comparison to brain death, and review of the literature. Obstet Gynecol Surv. 2003;58:738–48.CrossRefPubMedGoogle Scholar
  20. 20.
    McCullough LB, Chervenak FA. Ethics in obstetrics and gynecology. New York: Oxford University Press; 1994.Google Scholar
  21. 21.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. 4th ed. New York: Oxford University Press; 1994.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Elissa Fory Wible
    • 1
  • Joseph S. Kass
    • 2
  • George A. Lopez
    • 3
  1. 1.Department of MedicineDuke University Medical CenterDurhamUSA
  2. 2.Department of NeurologyBaylor College of MedicineHoustonUSA
  3. 3.Department of NeurologyUniversity of Texas Health Science Center at HoustonHoustonUSA

Personalised recommendations