Tuesday, October 20, 2015

Cardiac Arrest in Pregnancy AHA scientific statement on maternal resuscitation

October 19, 2015
The American Heart Association’s (AHA) scientific statement on maternal resuscitation includes up-to-date and comprehensive information, guidelines, and recommendations for all aspects of maternal resuscitation. The statement is intended to help health care providers be prepared and provide the best possible care for a maternal cardiac arrest. Among the recommendations are:
• The newly developed in-hospital and out-of-hospital basic life support and advanced cardiovascular life support algorithms should be the backbone of the response plan to a maternal cardiac arrest.
• Special attention should be paid to manual left uterine displacement (LUD), the difficult airway, and appropriate use of perimortem cesarean delivery (PMCD).
• A maternal cardiac arrest committee must be formed at every institution.
• Emergency response plans specific to each institution must be developed and implemented.
Citation: Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac arrest in pregnancy: A scientific statement from the American Heart Association. [Published online ahead of print October 6, 2015]. Circulation. doi: 10.1161/CIR.0000000000000300. 
Prepare for emergent c-section as soon as cardiac arrest identified in the pregnant woman 
Quickly determine gestational age during initial resuscitation of mother 
Once procedure begins, ideally two teams now working independently 
 CPR is continued on mother Factors that increase the infant’s chance of survival 
 Short interval between arrest and delivery 
 No sustained prearrest hypoxia of mother 
 Minimal or no signs of fetal distress before arrest 
 Aggressive/effective resuscitation of mother 
 Procedure performed in center with neonatal ICU 
 Emergency C-section within rescuer’s procedural range of experience/skills

Katz and colleagues recommended 
 “initiation of C-section within 4 minutes of maternal arrest and fetal delivery within 5 minutes.” These recs have been supported by other studies and consensus panels 
Forms the basis of the “4 minute” rule 
Case reports of prolonged time (>20) do not make this “4 minute rule “ absolute

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