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Twieg M, Eble M, Stadler R, Koenig B, Wenzel V. [Severe traffic accident on the hospital grounds]. DIE ANAESTHESIOLOGIE 2024; 73:412-416. [PMID: 38748209 DOI: 10.1007/s00101-024-01415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Martin Twieg
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Friedrichshafen, Röntgenstraße 2, 88048, Friedrichshafen, Deutschland.
| | - Martin Eble
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Friedrichshafen, Röntgenstraße 2, 88048, Friedrichshafen, Deutschland
| | - Reinhard Stadler
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Friedrichshafen, Röntgenstraße 2, 88048, Friedrichshafen, Deutschland
| | - Bernd Koenig
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Friedrichshafen, Friedrichshafen, Deutschland
| | - Volker Wenzel
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Friedrichshafen, Röntgenstraße 2, 88048, Friedrichshafen, Deutschland
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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2
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Weißleder A, Beinkofer D, Gässler H, Treffer D, Dargel S, Schleußner E. [Cardiopulmonary resuscitation of pregnant patients in the rescue service]. Notf Rett Med 2022; 25:359-368. [PMID: 35194395 PMCID: PMC8852988 DOI: 10.1007/s10049-022-00979-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022]
Abstract
Cardiopulmonary resuscitation of a pregnant patient is a rarity in prehospital emergency medicine and an extraordinary challenge for the emergency team. Besides modifications to emergency medical procedures due to physiological changes during pregnancy, specific reversible causes must be considered and psychosocial difficulties must be managed. This article aims to present a standard operating procedure for this special situation. In these circumstances the basics of crew resource management (CRM) are of special interest for the emergency team and are therefore mentioned in this article.
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Affiliation(s)
- Anne Weißleder
- Klinik für Gynäkologie XX, Bundeswehrkrankenhaus Westerstede, Lange Str. 38, 26655 Westerstede, Deutschland
| | - Daniela Beinkofer
- SG VI-2.2 Gesundheitsrisikobewertung/-Information, Kommando Sanitätsdienst der Bundeswehr, Koblenz, Deutschland
| | - Holger Gässler
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin & Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Dominik Treffer
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerzmedizin, Klinikum St. Elisabeth Straubing, Straubing, Deutschland
| | - Susanne Dargel
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Deutschland
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3
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Woods M. Prehospital Perimortem Caesarean Section - A Survivor. PREHOSP EMERG CARE 2019; 24:595-599. [PMID: 31550177 DOI: 10.1080/10903127.2019.1671563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cardiac arrest in pregnancy is rare. It has a reported incidence of approximately 1 in 30000 pregnancies worldwide and occurs prehospitally with rates of around 3 in every 100000 live births within the developed world. The management of maternal cardiac arrest is complicated by the anatomical and physiological changes of pregnancy, its rarity and clinician unfamiliarity. The presentation and the prehospital environment can make for an incredibly challenging, stressful and highly emotive scene. One aspect of maternal cardiac arrest management is the perimortem cesarean section, a surgical procedure that is potentially lifesaving for both mother and child. Although rarely reported in the field it is possible to successfully perform the procedure. This report details the emergent prehospital treatment of a 41-year-old woman pregnant with her first child of 30 weeks gestation. It describes a case of maternal cardiac arrest, her resuscitation and the undertaking of a prehospital perimortem cesarean section resulting in a neurologically intact infant survivor.
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Comito C, Bechi L, Serena C, Checcucci V, Mori E, Micaglio M, Mecacci F, Petraglia F. Cardiac arrest in the delivery room after spinal anesthesia for cesarean section: a case report and review of literature. J Matern Fetal Neonatal Med 2018; 33:1456-1458. [PMID: 30246574 DOI: 10.1080/14767058.2018.1517321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cardiac arrest in pregnancy is a rare event due to different cause. When it occurs after spinal anesthesia a cause that can explain this event is the Bezold-Jarish Reflex (BJR). A cardiac arrest occurs in a pregnant women after spinal anesthesia admistered for urgent caesarean section. During this event perimortem caesarean delivery (PMCD) is the rapid surgical way that can improve maternal and fetal outcomes. In this situation, it is very important to have a multidisciplinary team of midwives, obstetricians, anesthetists, neonatologists, intensivists that is able to perform perimortem caesarean delivery according to the guidelines.
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Affiliation(s)
- Chiara Comito
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Lorenzo Bechi
- Department of Maternal Anesthesia, DAIMI, Careggi University Hospital, Florence, Italy
| | - Caterina Serena
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Vanni Checcucci
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Emanuele Mori
- Department of Maternal Anesthesia, DAIMI, Careggi University Hospital, Florence, Italy
| | - Massimo Micaglio
- Department of Maternal Anesthesia, DAIMI, Careggi University Hospital, Florence, Italy
| | - Federico Mecacci
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
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Ejima E, Murasato Y. A case of cardiopulmonary arrest due to spontaneous coronary artery dissection in a pregnant woman. BMJ Case Rep 2017; 2017:bcr-2017-220119. [PMID: 28814587 DOI: 10.1136/bcr-2017-220119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a young pregnant woman with cardiopulmonary arrest due to acute coronary syndrome. Emergent coronary angiography (CAG) and intravascular ultrasound (IVUS) showed extensive coronary artery dissection in the left anterior descending artery, which was treated with primary percutaneous coronary intervention. After managing the heart failure and disseminated intravascular coagulation, a dead fetus was delivered via caesarean section 4 days after admission to the hospital. Follow-up CAG and IVUS at 18 months showed persistent dissection in the non-stented site; hence, another stent was implanted. Dual antiplatelet therapy was discontinued 6 months later; however, aspirin and beta-blockers were continued lifelong.
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Affiliation(s)
- Emiko Ejima
- Division of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yoshinobu Murasato
- Division of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Tommila M, Pystynen M, Soukka H, Aydin F, Rantanen M. Two cases of low birth weight infant survival by prehospital emergency hysterotomy. Scand J Trauma Resusc Emerg Med 2017; 25:62. [PMID: 28673308 PMCID: PMC5496320 DOI: 10.1186/s13049-017-0407-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During maternal cardiac arrest, emergency hysterotomy (EH) is recommended after four minutes of resuscitation, if no signs of spontaneous circulation are detected. This extreme procedure is believed to be potentially beneficial for both the mother and the infant. Both maternal and neonatal survivals seem to be associated to the time delay between the cardiac arrest and the delivery and in-hospital resuscitation location. In addition to this, gestational age is an important determinant to neonatal outcome. CASE PRESENTATION We report two emergency hysterotomies executed in an out-of-hospital location. The infants delivered by EH were low birth weight infants and born 20-23 min after maternal cardiac arrest. Both infants survived and had normal physical and neurological growth at the age of two years. Unfortunately, mothers in these both cases died in the field. CONCLUSION Contrary to earlier beliefs, it is possible to perform a successful EH also in out-of-hospital setting, even with incomplete surgical skills. However, training and preparation are extremely important for achieving the highest possible readiness to treat maternal cardiac arrest situations also prehospitally.
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Affiliation(s)
- Miretta Tommila
- Emergency Medical Services, FinnHEMS 20, University of Turku and Turku University Hospital, Savitehtaankatu 1, Turku, Finland. .,Division of Perioperative Services, Intensive Care Medicine and Pain Management and Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland.
| | - Mikko Pystynen
- Emergency Medical Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Soukka
- Department of Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Fatih Aydin
- Emergency Medical Services, FinnHEMS 20, University of Turku and Turku University Hospital, Savitehtaankatu 1, Turku, Finland
| | - Matias Rantanen
- Division of Perioperative Services, Intensive Care Medicine and Pain Management and Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland
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Pecher S, Williams E. Out-of-hospital cardiac arrest in pregnancy with good neurological outcome for mother and infant. Int J Obstet Anesth 2017; 29:81-84. [DOI: 10.1016/j.ijoa.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022]
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Paech MM. IJOA: a global vehicle to bolster the objectives of obstetric anaesthesiology. Int J Obstet Anesth 2016; 29:8-9. [PMID: 28012861 DOI: 10.1016/j.ijoa.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Mike Paech
- Professor of Obstetric Anaesthesia, The University of Western Australia, Perth, WA, Australia.
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