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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