Peripartum Cardiac Arrest 

 

 

Considerations 

 

  • Two patients with efforts focused on maternal resuscitation

  • Pregnancy considerations (difficult intubation, aspiration, ↓ time to desaturation, aortocaval compression, 2 patients)

  • Need for modified ACLS techniques:

    • Supradiaphragmatic IV 

    • Left uterine displacement

    • Chest compressions higher on sternum than usual

    • Early intubation 

    • Prepare for peri-mortem cesarean section; if no ROSC within 4 minutes of resuscitation, aim for delivery within 5 minutes of resuscitation

  • Rapid diagnosis & treatment of underlying etiology:

    • BEAU-CHOPS, H'sT's, MgSO4 toxicity, local anesthetic toxicity

  • Aggressive interventions for difficult resuscitation (cardiopulmonary bypass, hypothermia, internal cardiac massage)

 

 

Differential Diagnosis 

 

BEAU-CHOPS + H'sT's:

  • B leeding/DIC

  • E mbolism: coronary/pulmonary/AFE

  • A nesthetic complications (high spinal, aspiration, failed airway, local anesthetic toxicity)

  • U terine atony

  • C ardiac disease (MI/ischemia/aortic dissection/cardiomyopathy)

  • H ypertension/preeclampsia/eclampsia

  • O ther: differential diagnosis of standard ACLS guidelines ("H'sT's")

    • ​Hyper-/hypokalemia, hypothermia, hypovolemia, hydrogen ion (acidosis), hypoxia 

    • Tension pneumothorax, tamponade (cardiac), thrombus (coronary, pulmonary), toxins

  • P lacenta abruptio/previa

  • S epsis

 

 

Gestational Age & Viability      

 

  • Fetal viability begins at approximately 24-25 weeks

  • Estimate gestational age:

    • <20 weeks: urgent cesarean section need not be considered because a gravid uterus of this size is unlikely to significantly compromise cardiac output

    • 20-23 weeks: consider cesarean section for maternal resuscitation NOT survival of infant

    • > 24 weeks: cesarean section within 5 minutes for maternal & fetal resuscitation