Decreasing Mortality in Cardiac Arrest During Pregnancy
This study by Beckett et al. (BJOG, 2017) aimed to explore the rate, risks, management, and outcomes of cardiac arrest during pregnancy.
Prospective Cohort Study
Data from 66 maternal cardiac arrests occurred in the UK from July 2011-July 2014 were assessed., with an incidence of 2.78 per 100,000 pregnancies. 28 of the women (42%) died, and they were more likely to have collapsed somewhere other than the hospital. Women who survived had a much shorter time from collapse to perimortem C-section (3 minutes vs. 12 minutes for women who did not survive, P=0.001). 16 of the women (24%) went into cardiac arrest because of obstetric anesthesia, of these women, 12 were obese, and for all the women basic and advanced life support was quickly delivered. Perimortem C-sections were performed in 49 of the women, 11 in the emergency department. 46 of 58 babies were born alive, 32 to surviving mothers, and 14 to women who died. Close to a 25% of these women experienced cardiac arrest caused by anesthesia. Quick perimortem C-sections also increase chance of survival.
The mini-commentary by Mnyre and Bateman compare the UK to the US data. In the UK, the primary cause of arrest was due to anesthetic complications. Obesity resulted in difficulty in airway maintenance during general anesthesia and hemodynamic management of neuraxial anesthesia. Women thankfully survived due to appropriate resuscitation efforts. High neuraxial blockade was an issue in 13/16 cases. In the US data, many such ‘high blocks’ were the result of unrecognized spinal insertion rather than epidural placement or spinal attempt after a failed epidural. In the US, hemorrhage accounted for 38% of arrests while in the UK data, this was the second most common cause of arrest (22%) where survival was only 5/13. The authors suggest that while the CAPS data validate current practices, there is room for improvement.
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