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Larson NJ, Mergoum AM, Dries DJ, Hubbard L, Blondeau B, Rogers FB. Perimortem cesarean section after severe injury: What you need to know. J Trauma Acute Care Surg 2024; 97:670-677. [PMID: 39225781 DOI: 10.1097/ta.0000000000004444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
ABSTRACT When pregnant patients are involved in traumatic incidents, the trauma clinician encounters two patients-both the mother and the unborn child. Advanced trauma life support dictates that the first priority is the life of the mother; however, there are rare situations where to provide the greatest chance of survival for both the mother and baby, an emergency cesarean section (perimortem cesarean delivery [PMCD]) must be performed. The decision to perform this procedure must occur quickly, and the reality is that a board-certified obstetrician is rarely present, particularly in rural areas. In this review, we provide a rationale for why trauma clinicians should be conversant with PMCDs, present the specific time limitations for performing a PMCD, and discuss the technique to perform a successful PMCD that makes it distinctly different from an elective cesarean delivery. Finally, we will discuss some things that a trauma program can do proactively in an obstetrical resource-poor area of the country to prepare for the rare instances where these procedures are necessary.
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Affiliation(s)
- Nicholas J Larson
- From the Department of Surgery (N.J.L., A.M.M., D.J.D., B.B., F.B.R.), and Department of Obstetrics and Gynecology (L.H.), Regions Hospital, Saint Paul, Minnesota
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Chin HR, Ng WX. Low-Cost, Scalable Simulations in Obstetric Trauma and Resuscitative Hysterotomy for Emergency Medicine Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11452. [PMID: 39363916 PMCID: PMC11447011 DOI: 10.15766/mep_2374-8265.11452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 06/06/2024] [Indexed: 10/05/2024]
Abstract
Introduction Simulation-based learning is essential for health care providers to prepare for rare obstetric emergencies, such as severe trauma and maternal cardiac arrest. These situations demand rapid and prompt actions, often testing the skill of emergency physicians. Resuscitative hysterotomy (RH), a critical procedure in maternal cardiac arrest, requires technical expertise, coordination, and anatomical knowledge. The high cost of commercial trainers and complex existing models restricts accessibility. This resource introduces a low-cost anatomically accurate RH task trainer and assesses its effectiveness in improving skills and confidence among trainee emergency physicians. Methods A 20-minute-long case scenario depicted the resuscitation of a pregnant trauma patient with tension pneumothorax and uterine rupture, culminating in maternal cardiac arrest necessitating RH. Residents performed RH on the task trainer under faculty guidance. Feedback followed the Pendleton model, and an online questionnaire gauged the residents' experiences. Results Thirty emergency medicine residents participated in the simulation. The questionnaire revealed positive responses, confirming the session's relevance and enhancement of clinical skills and confidence. Discussion Our results underscore the RH task trainer's critical role in improving residents' skills and confidence during obstetric trauma simulations. Its realism and effectiveness were notably well received. Future refinements aim to augment fidelity while preserving affordability and integrating regular reinforcement sessions. This innovative educational approach equips health care professionals to respond adeptly to rare and challenging obstetric emergencies, ultimately elevating outcomes for mothers and infants during critical situations.
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Affiliation(s)
- Hao Ren Chin
- Associate Consultant, Department of Emergency Medicine, Tan Tock Seng Hospital
- Co-primary author
| | - Wei Xiang Ng
- Consultant, Department of Emergency Medicine, Tan Tock Seng Hospital
- Co-primary author
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3
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Aftab N, Halalmeh DR, Vrana A, Smitterberg C, Cranford JA, Sachwani-Daswani GR. Enhancing maternal survival in traumatic cardiovascular collapse during pregnancy: A case series on resuscitative hysterotomy (RH) from a level 1 trauma center. Injury 2024:111923. [PMID: 39349316 DOI: 10.1016/j.injury.2024.111923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 09/13/2024] [Accepted: 09/21/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND Trauma during pregnancy presents multifaceted risks to both the developing fetus and the expectant mother due to pregnancy-induced physiological adaptations that affect the response to traumatic injuries. The infrequent occurrence of cardiac arrest during pregnancy necessitates interventions such as perimortem cesarean section (PMCS), now termed resuscitative hysterotomy. While early resuscitative hysterotomy focused primarily on fetal survival, more recent literature reports substantial maternal benefits. Resuscitative hysterotomy can lead to the restoration of maternal pulse and blood pressure within minutes and has shown potential to improve maternal outcomes. RH has been demonstrated to aid in fetal and maternal survival in hemodynamic unstable pregnant patients before cardiovascular collapse. The linguistic change from PMCS to resuscitative hysterotomy is a shift towards maternal-centric approaches and survival. OBJECTIVE In this series, we evaluate the outcomes of resuscitative hysterotomy performed before or after cardiovascular collapse to maximize maternal survival while concurrently optimizing fetal outcomes. METHODS We performed a retrospective case series review of 4 consecutive pregnant trauma patients who underwent RH due to hemodynamic instability. In addition, we conducted a descriptive analysis of all pregnant patients from 2013 to May 2024 who presented due to a traumatic injury but did not require a RH. RESULTS The average age of patients undergoing RH was 26.5 ± 6.8 years. All patients were in the third trimester with a mean gestational age of 32.3 ± 0.5 weeks. Fifty percent (50 %) of patients were involved in motor vehicle accidents, one (25 %) pedestrian was hit by a vehicle, and one (25 %) had GSW to the head. The median time to RH was 14.5 min. The mean estimated blood loss (EBL) was 625 mL ±108.9 mL. The maternal survival rate was 50 %, with a fetal survival rate of 100 %. Three patients achieved hemodynamic stability; however, one of the patients progressed to death by neurological criteria. Therefore, we achieved 50 % of maternal survival. A resuscitative hysterotomy was performed due to early signs of maternal hemorrhagic shock and suggestive features of ongoing bleeding (persistent maternal tachycardia despite adequate analgesia and resuscitation, persistent maternal bradycardia, gradual decline of BP, and FHR abnormalities) in three patients. The remaining patient was found to have cardiac arrest at the scene with a brief return of spontaneous circulation and received resuscitative hysterotomy in the ED to restore cardiovascular function. CONCLUSION RH in pregnant patients with traumatic injury and impending hemorrhagic shock or cardiovascular collapse may provide maternal survival benefits by supporting circulatory function and promoting resuscitation with no additional risks to fetal outcomes. Quick decision-making is crucial to the implementation of this life-saving procedure. Further research with a more significant number of patients is needed to validate the efficacy of RH in maximizing maternal survival. This case series adds to the evolving literature on RH, shedding light on practical aspects and maternal outcomes to inform ongoing discussions and strategies for maternal cardiopulmonary resuscitation.
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Affiliation(s)
- Neha Aftab
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, MI, USA; Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Dia R Halalmeh
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, MI, USA; Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Antonia Vrana
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, MI, USA.
| | - Chase Smitterberg
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, MI, USA.
| | - James A Cranford
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Gul R Sachwani-Daswani
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, MI, USA; Michigan State University College of Human Medicine, East Lansing, MI, USA.
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4
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Sumer RW, Woods WA. Cardiac Arrest in Special Populations. Cardiol Clin 2024; 42:289-306. [PMID: 38631796 DOI: 10.1016/j.ccl.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.
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Affiliation(s)
- Ravi W Sumer
- Department of Emergency Medicine, 4601 Dale Road, Modesto, CA 95356-8713, USA.
| | - William A Woods
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699, USA
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5
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Awad KG, Nahmias J, Aryan N, Lucas AN, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Tay-Lasso E, Zezoff DC, Grigorian A. Outcomes of severely injured pregnant trauma patients: a multicenter analysis. Updates Surg 2024:10.1007/s13304-024-01817-3. [PMID: 38554224 DOI: 10.1007/s13304-024-01817-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
Nearly 10% of pregnant women suffer traumatic injury. Clinical outcomes for pregnant trauma patients (PTPs) with severe injuries have not been well studied. We sought to describe outcomes for PTPs presenting with severe injuries, hypothesizing that PTPs with severe injuries will have higher rates of complications and mortality compared to less injured PTPs. A post-hoc analysis of a multi-institutional retrospective study at 12 Level-I/II trauma centers was performed. Patients were stratified into severely injured (injury severity score [ISS] > 15) and not severely injured (ISS < 15) and compared with bivariate analyses. From 950 patients, 32 (3.4%) had severe injuries. Compared to non-severely injured PTPs, severely injured PTPs were of similar maternal age but had younger gestational age (21 vs 26 weeks, p = 0.009). Penetrating trauma was more common in the severely injured cohort (15.6% vs 1.4%, p < 0.001). The severely injured cohort more often underwent an operation (68.8% vs 3.8%, p < 0.001), including a hysterectomy (6.3% vs 0.3%, p < 0.001). The severely injured group had higher rates of complications (34.4% vs 0.9%, p < 0.001), mortality (15.6% vs 0.1%, p < 0.001), a higher rate of fetal delivery (37.5% vs. 6.0%, p < 0.001) and resuscitative hysterotomy (9.4% vs. 0%, p < 0.001). Only approximately 3% of PTPs were severely injured. However, severely injured PTPs had a nearly 40% rate of fetal delivery as well as increased complications and mortality. This included a resuscitative hysterotomy rate of nearly 10%. Significant vigilance must remain when caring for this population.
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Affiliation(s)
- Kyrillos G Awad
- Department of Surgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Negaar Aryan
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Alexa N Lucas
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Sigrid Burruss
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Alden Dahan
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Areti Tillou
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Rahul Tuli
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego School of Medicine, University of California, San Diego, CA, USA
| | - Brent Emigh
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Erika Tay-Lasso
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Danielle C Zezoff
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Areg Grigorian
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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7
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Brennan KA, Angelidis IK. Resuscitation in obstetric care. Int Anesthesiol Clin 2023; 61:55-61. [PMID: 37622314 DOI: 10.1097/aia.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Kaitlyn A Brennan
- Department of Anesthesiology & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennesse
| | - Ioannis K Angelidis
- New York University, Grossman School of Medicine, New York, New York
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
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8
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Wolff J, Breuer F, von Kottwitz K, Poloczek S, Röschel T, Dahmen J. [Prehospital perimortem cesarean section during cardiopulmonary resuscitation for traumatic cardiac arrest : Case report and lessons learned]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:727-735. [PMID: 35947175 PMCID: PMC10449654 DOI: 10.1007/s00113-022-01220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
The following case report discusses the resuscitation of a pregnant woman in traumatic cardiac arrest after a fall from a height with consecutive resuscitative hysterotomy for maternal and fetal salvage. The report illustrates all lessons learned from critical appraisal amid new guideline recommendations and gives an overview of the published literature on the matter. Despite extensive resuscitation efforts, ultimately both the mother and the newborn were pronounced life extinct at the scene. Prehospital treatment of (traumatic) cardiac arrest in a pregnant patient as well as performing a perimortem cesarean section remain infrequent but challenging scenarios.
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Affiliation(s)
- Justus Wolff
- Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Florian Breuer
- Ärztliche Leitung Rettungsdienst Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Bergisch Gladbach, Deutschland
| | | | - Stefan Poloczek
- Ärztliche Leitung Rettungsdienst Berlin, Berliner Feuerwehr, Berlin, Deutschland
| | - Tom Röschel
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - Janosch Dahmen
- Ärztliche Leitung Rettungsdienst Berlin, Berliner Feuerwehr, Berlin, Deutschland.
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten/Herdecke, Deutschland.
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9
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Sumer RW, Woods WA. Cardiac Arrest in Special Populations. Emerg Med Clin North Am 2023; 41:485-508. [PMID: 37391246 DOI: 10.1016/j.emc.2023.05.001] [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: 07/02/2023]
Abstract
Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.
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Affiliation(s)
- Ravi W Sumer
- Department of Emergency Medicine, 4601 Dale Road, Modesto, CA 95356-8713, USA.
| | - William A Woods
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699, USA
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10
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Downing J, Sjeklocha L. Trauma in Pregnancy. Emerg Med Clin North Am 2023; 41:223-245. [PMID: 37024160 DOI: 10.1016/j.emc.2022.12.001] [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: 04/08/2023]
Abstract
Trauma is the leading cause of nonobstetric maternal death. Pregnant patients have a similar spectrum of traumatic injuries with a noted increase in interpersonal violence. A structured approach to trauma evaluation and management is recommended with several guidelines expanding on ATLS principles; however, evidence is limited. Optimal management requires understanding of physiologic changes in pregnancy, a team-based approach, and preparation for interventions that may including neonatal resuscitation. The principles of trauma management are the same in pregnancy with a systematic approach and initial maternal focused resuscitation..
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Affiliation(s)
- Jessica Downing
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Lucas Sjeklocha
- Department of Emergency Medicine, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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11
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The Big Five—Lifesaving Procedures in the Trauma Bay. Emerg Med Clin North Am 2023; 41:161-182. [DOI: 10.1016/j.emc.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Hardeland C, Svendsen EJ, Heitmann GB, Leonardsen AL. Healthcare personnel self-assessed competence and knowledge following implementation of a new guideline on maternal resuscitation in Norway. A repeated measure study. Health Sci Rep 2023; 6:e1035. [PMID: 36698715 PMCID: PMC9847399 DOI: 10.1002/hsr2.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Cardiac arrest in pregnancy is a rare, yet extremely challenging condition to manage for all healthcare personnel involved. Knowledge deficits and poor resuscitation skills can affect outcomes in cardiac arrest in pregnancy, but research exploring healthcare personnel competence and knowledge about maternal resuscitation is limited. Aims The aim of this study was to explore (1) healthcare personnel self-assessed competence and knowledge about cardiopulmonary resuscitation (CPR) in pregnancy as well as perimortem caesarean section, before and after implementation of a new guideline, (2) whether there were any interprofessional differences in knowledge about maternal resuscitation, and (3) potential differences between different implementation strategies. Research Methodology The study had a prospective repeated measure implementation design, utilizing a questionnaire before and after implementation of a new guideline on maternal resuscitation after cardiac arrest. Setting All healthcare personnel potentially involved in CPR in six hospital wards, were invited to participate (n = 527). The guideline was implemented through either simulation, table-top discussions and/or an electronical learning course. Results In total, 251 (48%) participants responded to the pre-questionnaire, and 182 (35%) to the postquestionnaire. The need for education and training/simulation concerning maternal resuscitation were significantly lowered after implementation of the guideline, yet still the majority of respondents reported a high to medium need for education and training/simulation. Participants' self-assessed overall competence in maternal resuscitation increased significantly postimplementation. Regardless of professional background, knowledge about CPR and perimortem caesarean section increased significantly in most items in the questionnaire after implementation. Differences in level of knowledge based on implementation strategy was identified, but varied between items, and was therefore inconclusive. Conclusion This study adds knowledge about healthcare personnel self-assessed competence and knowledge about maternal resuscitation and perimortem caesarean section in pregnancy. Our findings indicate that there is still a need for more education and training in this rare incident.
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Affiliation(s)
- Camilla Hardeland
- Faculty of Health, Welfare and OrganisationØstfold University CollegeHaldenNorway
| | - Edel J. Svendsen
- Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
- Department of Nursing and Health PromotionOslo Metropolitan UniversityOsloNorway
- Department of ResearchSunnaas Rehabilitation HospitalBjørnemyrNorway
| | | | - Ann‐Chatrin L. Leonardsen
- Faculty of Health, Welfare and OrganisationØstfold University CollegeHaldenNorway
- Department of AnesthesiologyØstfold Hospital TrustSarpsborgNorway
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13
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Knapp C, Bhatia K. Maternal collapse in pregnancy. Br J Hosp Med (Lond) 2022; 83:1-12. [PMID: 36594762 DOI: 10.12968/hmed.2022.0259] [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: 12/13/2022]
Abstract
Maternal collapse is a rare life-threatening event that can occur at any stage of pregnancy or up to 6 weeks postpartum. Prompt identification and timely intervention by a multidisciplinary team that includes an obstetrician, midwifery staff and an obstetric anaesthetist are essential to improve maternal and fetal outcomes. Standard adult resuscitation guidelines need to be followed with some modifications, taking into account the maternal-fetal physiology, which clinicians should be familiar with. During cardiac arrest, the emphasis is on advanced airway management, manual uterine displacement to relieve aortocaval compression and performing a resuscitative hysterotomy (peri-mortem caesarean delivery) swiftly in patients who are more than 20 weeks gestation to improve maternal survival. Annual multidisciplinary simulation training is recommended for all professionals involved in maternity care; this can improve teamwork, communication and emergency preparedness during maternal collapse.
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Affiliation(s)
- C Knapp
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, St Mary's Hospital, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
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14
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Resende MHF, Yarnell CJ, D'Souza R, Lapinsky SE, Nam A, Shah V, Whittle W, Wright JK, Naimark DMJ. Clinical decision analysis of elective delivery vs expectant management for pregnant individuals with COVID-19-related acute respiratory distress syndrome. Am J Obstet Gynecol MFM 2022; 4:100697. [PMID: 35878805 PMCID: PMC9307282 DOI: 10.1016/j.ajogmf.2022.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pregnant individuals are vulnerable to COVID-19-related acute respiratory distress syndrome. There is a lack of high-quality evidence on whether elective delivery or expectant management leads to better maternal and neonatal outcomes. OBJECTIVE This study aimed to determine whether elective delivery or expectant management are associated with higher quality-adjusted life expectancy for pregnant individuals with COVID-19-related acute respiratory distress syndrome and their neonates. STUDY DESIGN We performed a clinical decision analysis using a patient-level model in which we simulatedpregnant individuals and their unborn children. We used a patient-level model with parallel open-cohort structure, daily cycle length, continuous discounting, lifetime horizon, sensitivity analyses for key parameter values, and 1000 iterations for quantification of uncertainty. We simulated pregnant individuals at 32 weeks of gestation, invasively ventilated because of COVID-19-related acute respiratory distress syndrome. In the elective delivery strategy, pregnant individuals received immediate cesarean delivery. In the expectant management strategy, pregnancies continued until spontaneous labor or obstetrical decision to deliver. For both pregnant individuals and neonates, model outputs were hospital or perinatal survival, life expectancy, and quality-adjusted life expectancy denominated in years, summarized by the mean and 95% credible interval. Maternal utilities incorporated neonatal outcomes in accordance with best practices in perinatal decision analysis. RESULTS Model outputs for pregnant individuals were similar when comparing elective delivery at 32 weeks' gestation with expectant management, including hospital survival (87.1% vs 87.4%), life-years (difference, -0.1; 95% credible interval, -1.4 to 1.1), and quality-adjusted life expectancy denominated in years (difference, -0.1; 95% credible interval, -1.3 to 1.1). For neonates, elective delivery at 32 weeks' gestation was estimated to lead to a higher perinatal survival (98.4% vs 93.2%; difference, 5.2%; 95% credible interval, 3.5-7), similar life-years (difference, 0.9; 95% credible interval, -0.9 to 2.8), and higher quality-adjusted life expectancy denominated in years (difference, 1.3; 95% credible interval, 0.4-2.2). For pregnant individuals, elective delivery was not superior to expectant management across a range of scenarios between 28 and 34 weeks of gestation. Elective delivery in cases where intrauterine death or maternal mortality were more likely resulted in higher neonatal quality-adjusted life expectancy, as did elective delivery at 30 weeks' gestation (difference, 1.1 years; 95% credible interval, 0.1 - 2.1) despite higher long-term complications (4.3% vs 0.5%; difference, 3.7%; 95% credible interval, 2.4-5.1), and in cases where intrauterine death or maternal acute respiratory distress syndrome mortality were more likely. CONCLUSION The decision to pursue elective delivery vs expectant management in pregnant individuals with COVID-19-related acute respiratory distress syndrome should be guided by gestational age, risk of intrauterine death, and maternal acute respiratory distress syndrome severity. For the pregnant individual, elective delivery is comparable but not superior to expectant management for gestational ages from 28 to 34 weeks. For neonates, elective delivery was superior if gestational age was ≥30 weeks and if the rate of intrauterine death or maternal mortality risk were high. We recommend basing the decision for elective delivery vs expectant management in a pregnant individual with COVID-19-related acute respiratory distress syndrome on gestational age and likelihood of intrauterine or maternal death.
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Affiliation(s)
- Maura H Ferrari Resende
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Sunnybrook Health Sciences Centre, Toronto, Canada (Drs Ferrari Resende and Naimark)
| | - Christopher J Yarnell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Critical Care Medicine, Sinai Health System and the University Health Network, Toronto, Canada (Dr Yarnell and Dr Lapinsky).
| | - Rohan D'Souza
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada (Dr D'Souza); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, University of Toronto, Toronto, Canada (Drs D'Souza and Whittle)
| | - Stephen E Lapinsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Critical Care Medicine, Sinai Health System and the University Health Network, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
| | | | - Vibhuti Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada (Dr Shah)
| | - Wendy Whittle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, University of Toronto, Toronto, Canada (Drs D'Souza and Whittle)
| | - Julie K Wright
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada (Dr Wright); Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada (Dr Wright); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Sunnybrook Health Sciences Centre, Toronto, Canada (Drs Ferrari Resende and Naimark); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
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15
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Saroyo YB, Wibowo N, Prasmusinto D, Purwosunu Y, Irwinda R, Dilmy MAF, Putri A, Wijaya A. Perimortem caesarean section in COVID-19 era. J OBSTET GYNAECOL 2022; 42:2629-2633. [PMID: 36193732 DOI: 10.1080/01443615.2022.2126298] [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: 01/06/2023]
Abstract
Cardiac arrest in pregnancy is very rare. Various methods have been proposed to return spontaneous circulation and prevent mortality, such as Perimortem Caesarean Section (PMCS). Since 2019, the COVID-19 pandemic has added to the difficulty in decision making and performing PMCS. Infection prevention being a priority due to the rapid spreading of the virus could cause hesitation upon initiating an emergency procedure, especially PMCS. We have reviewed the issues impacting on basic and advanced life support in adults with suspected or confirmed COVID-19.
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Affiliation(s)
- Yudianto Budi Saroyo
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Noroyono Wibowo
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Damar Prasmusinto
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yuditiya Purwosunu
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rima Irwinda
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mohammad Adya Firmansha Dilmy
- Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Angela Putri
- Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Andrew Wijaya
- Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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16
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Howard C, Naim O, Chalhoub G, Rodriguez E, Miles J. Spontaneous Pulmonary Embolism Leading to Sudden Cardiac Arrest and Perimortem C-Section in a 39-Week Parturient During Induction of Labor: A Case Report. Cureus 2022; 14:e29121. [PMID: 36258925 PMCID: PMC9559798 DOI: 10.7759/cureus.29121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
We report the successful salvage of mother and baby after a perimortem cesarean delivery (PMCD) complicated by a 21-minute asystolic maternal cardiac arrest (MCA) that was precipitated by a pulmonary embolism during the early stages of induction of labor. With rapid PMCD, recovery of maternal quality of life is possible even after prolonged resuscitation.
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17
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Pacheco LD, Shepherd MC, Saade GS. Septic Shock and Cardiac Arrest in Obstetrics: A Practical Simplified Clinical View. Obstet Gynecol Clin North Am 2022; 49:461-471. [PMID: 36122979 DOI: 10.1016/j.ogc.2022.02.002] [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: 10/14/2022]
Abstract
Septic shock and cardiac arrest during pregnancy, despite being uncommon, carry a high mortality rate among pregnant individuals. Basic initial management strategies are fundamental to improve clinical outcomes; obstetricians and maternal-fetal medicine specialists need to be familiar with such interventions.
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Affiliation(s)
- Luis D Pacheco
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, and Anesthesiology, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0587, USA; Department of Obstetrics & Gynecology, Division of Surgical Critical Care, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0587, USA.
| | - Megan C Shepherd
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0587, USA
| | - George S Saade
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-0587, USA
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18
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Shields AD, Battistelli JD, Kavanagh LB, Thomson BA, Nielsen PE. A modified Delphi approach to determine current treatment advances for the development of a resuscitation program for maternal cardiac arrest. BMC Emerg Med 2022; 22:149. [PMID: 36028819 PMCID: PMC9419332 DOI: 10.1186/s12873-022-00704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Maternal cardiac arrest is a rare and complex process requiring pregnancy-specific responses and techniques. The goals of this study were to (1) identify, evaluate, and determine the most current best practices to treat this patient population and (2) establish a standardized set of guidelines to serve as a foundation for a future educational simulation-based curriculum. STUDY DESIGN We used a three-step modified Delphi process to achieve consensus. Twenty-two healthcare experts from across North America agreed to participate in the expert panel. In round 1, 12 pregnancy-specific best practice statements were distributed to the expert panel. Panelists anonymously ranked these using a 7-point Likert scale and provided feedback. Round 2 consisted of a face-to-face consensus meeting where statements that had not already achieved consensus were discussed and then subsequently voted upon by the panelists. RESULTS Through two rounds, we achieved consensus on nine evidence-based pregnancy-specific techniques to optimize response to maternal cardiac arrest. Round one resulted in one of the 12 best practice statements achieving consensus. Round two resulted in six of the remaining 12 gaining consensus. Best practice techniques involved use of point-of care ultrasound, resuscitative cesarean delivery, cardiopulmonary resuscitation techniques, and the use of extracorporeal cardiopulmonary resuscitation. CONCLUSION The results of this study provide the foundation to develop an optimal, long-term strategy to treat cardiac arrest in pregnancy. We propose these nine priorities for standard practice, curricula, and guidelines to treat maternal cardiac arrest and hope they serve as a foundation for a future educational curriculum.
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Affiliation(s)
- Andrea D. Shields
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT USA
| | - Jacqueline D. Battistelli
- Department of Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX USA
| | - Laurie B. Kavanagh
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT USA
| | - Brook A. Thomson
- Department of Obstetrics and Gynecology, University of Texas Health Sciences Center, San Antonio, TX USA
| | - Peter E. Nielsen
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT USA
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19
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Palm KH, Lei C, Walsh R, Heimiller J, Sikon J. An Inexpensive, High-Fidelity Resuscitative Hysterotomy (RH) Model With Hemorrhage Capability. Cureus 2022; 14:e25582. [PMID: 35784952 PMCID: PMC9249051 DOI: 10.7759/cureus.25582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Resuscitative hysterotomy (RH) is a rare, time-sensitive, invasive procedure that can be frightening for emergency physicians and yet potentially life-saving for fetus and mother. Several low-cost RH task trainers have been described in the literature. We set out to construct a model using improved synthetic materials for the uterine and abdominal wall and to devise hemorrhage capability. The primary aim of this study was to evaluate the model’s perceived usefulness of its features. Secondarily, we wished to assess the confidence of emergency medicine (EM) residents before and after performing a RH using our task trainer in a simulated environment. We constructed an inexpensive task trainer that can function both as a table-top model (TTM) and be adapted to a high-fidelity simulator. We created the abdominal wall and uterus from polyurethane carpet padding, subcutaneous fat from upholstery foam, fascia from synthetic chamois, and blood vessels from IV tubing and angio-catheters. We utilized the task trainer during our monthly EM residency simulation conference. After completing a simulation of a gravid female in cardiac arrest requiring a RH on a high-fidelity simulator adaptated model (HFSAM), residents repeated the procedure during debriefing on a TTM. Residents then completed anonymous paper surveys in which they rated aspects of the RH model and their procedural confidence on a 10-point Likert scale. 20 EM residents took part in the RH simulation scenario followed by a TTM demonstration. All (100%) residents completed the survey. 11 (55%) of the residents performed a RH on either the HFSAM or the TTM while the others assisted. The residents rated the overall educational value of the training event as very high (mean 9.8 (SD 0.68)). Both the TTM (mean 8.9 (SD 1.15)) and HFSAM (mean 8.7 (SD 1.29)) were similarly rated as highly realistic. Before the simulation session, residents rated their confidence in performing a RH as low (mean 4.0 (SD 2.62)). After the session, they were much more confident in their ability to perform a RH (mean 7.9 (SD 1.48); P<0.001). Most residents rated bleeding as very important to the utility of a RH model (mean 8.6 (SD 1.74)). We demonstrate an inexpensive but realistic RH task trainer that can be used as a stand-alone model or adapted to a high-fidelity simulator. A single simulation using the TTM and the HFSAM lead to increased resident confidence in their ability to perform a RH.
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20
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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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21
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Kong CW, To WWK. Impact of foeto-maternal resuscitation and perimortem caesarean section simulation training: An opinion survey of healthcare participants. HONG KONG J EMERG ME 2022. [DOI: 10.1177/10249079211072403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The incidence of maternal cardiac arrest is rising in recent years. Medical staff generally lack the experience of performing resuscitation on pregnant patients. Maternal cardiac arrest and perimortem caesarean section simulation training was newly introduced in the Advanced Life Support in Obstetrics provider courses in Hong Kong since April 2021. Objective: To evaluate the course participants’ opinions on maternal cardiac arrest simulation training. Methods: A questionnaire survey was conducted for all participants in the Advanced Life Support in Obstetrics provider course in April 2021 to assess their opinions on the usefulness of this training. Results: There were four Advanced Life Support in Obstetrics provider courses in April 2021 with 36 participants in each course, and 137 questionnaires were received at the end of the course. The response rate was 137/144 (95.1%). After excluding the questionnaires with incomplete information, 134 questionnaires were included for final analysis. Almost all of the participants agreed that the maternal cardiac arrest simulation training could help them in their work (97.8%), could improve their knowledge and skill (98.5%) and could improve team training and co-ordination (97.0%). The majority of them (97.0%) felt more confident in managing maternal cardiac arrest after the training, and 97.8% of participants felt that the perimortem caesarean section model was useful for training. Around 80% of the participants would recommend this course to their colleagues. There were no significant differences in opinions on the usefulness of this training among participants with regard to their specialty, whether they were doctors or nurses, their years of experience and the specific hospital settings. Conclusions: Maternal cardiac arrest simulation training was highly valued by all levels of obstetric, emergency medicine and anaesthesia staff in both public and private hospitals.
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Affiliation(s)
- Choi Wah Kong
- Advanced Life Support in Obstetrics (ALSO), Hong Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kowloon, Hong Kong
| | - William Wing Kee To
- Advanced Life Support in Obstetrics (ALSO), Hong Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kowloon, Hong Kong
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22
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Solaja O, Fehintola A, Adetoye A. Perimortem caesarean section. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_200_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Zasso FB, Nabecker S. Are we prepared for a sudden cardiac arrest in a pregnant patient? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Nivatpumin P, Lertbunnaphong T, Dittharuk D. A ten-year retrospective review of maternal cardiac arrest: Incidence, characteristics, causes, and outcomes in a tertiary-care hospital in a developing country. Taiwan J Obstet Gynecol 2021; 60:999-1004. [PMID: 34794763 DOI: 10.1016/j.tjog.2021.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Maternal cardiac arrest is rare. We retrospectively reviewed and reported (1) the incidence of maternal cardiac arrests during admissions for delivery; (2) the characteristics and causes of cardiac arrest; and (3) the mortality rate and outcomes in a referral, single-university, teaching hospital in Thailand. MATERIALS AND METHODS Data on 23 cardiac arrests during admissions for delivery in the decade January 2006-December 2015 were retrospectively chart-reviewed. Patients with gestational ages under 24 weeks or cardiac arrests and death occurring before hospital arrival were excluded. The clinical characteristics of the arrests and outcomes were collected. RESULTS Of 89,368 deliveries during the decade, 23 women suffered cardiac arrest (incidence, 1:3885), with 3 of those arrests occurring before delivery (incidence, 1:29,789). One patient underwent a perimortem cesarean delivery in the operating theatre. The most common reasons for the arrests were hypertension during pregnancy and cardiovascular causes (30.4% and 21.7%, respectively). Amniotic fluid embolisms were suspected for 2 patients (8.7%) with unidentified causes. The incidence of maternal deaths in peripartum cardiac arrests was 20/23, representing 86.9% (95% CI, 67.9-95.5) or 1:4468 of deliveries. Three patients suffering cardiac arrests after delivery survived to discharge. CONCLUSIONS We found a high maternal mortality rate following cardiac arrests during hospitalization for delivery. To decrease the incidence of arrests during the peripartum period and diminish the maternal mortality rate, identification of the causes and precipitating factors is vital. High-risk pregnant women require multidisciplinary care to improve the survival-to-discharge rate.
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Affiliation(s)
- Patchareya Nivatpumin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| | - Tripop Lertbunnaphong
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Doungdalad Dittharuk
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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25
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Seligman KM, Abir G. Emergency Resources in Obstetrics. Anesthesiol Clin 2021; 39:631-647. [PMID: 34776101 DOI: 10.1016/j.anclin.2021.08.004] [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: 10/19/2022]
Abstract
Utilization of emergency resources in obstetrics can help to optimize health care providers' care to pregnant and postpartum patients. There is a vast array of resources with various accessibility modalities that can be used before, during, and/or after an obstetric emergency. These resources can also be included as teaching material to increase knowledge and awareness with the aim to reduce maternal morbidity and mortality and improve patient outcomes.
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Affiliation(s)
- Katherine M Seligman
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H3N1, Canada
| | - Gillian Abir
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Academic Medicine, Stanford University School of Medicine, MC 5663, 453 Quarry Road, Palo Alto, CA 94304, USA.
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26
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Soar J, Becker LB, Berg KM, Einav S, Ma Q, Olasveengen TM, Paal P, Parr MJA. Cardiopulmonary resuscitation in special circumstances. Lancet 2021; 398:1257-1268. [PMID: 34454688 DOI: 10.1016/s0140-6736(21)01257-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022]
Abstract
Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.
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Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Lance B Becker
- Emergency Medicine, Zucker School of Medicine at Hofstra-Northwell, Northwell Health, New Hyde Park, NY, USA
| | | | - Sharon Einav
- Surgical Intensive Care, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Qingbian Ma
- Emergency Medicine, Peking University Third Hospital, Beijing, China
| | | | - Peter Paal
- Anaesthesiology and Intensive Care, St John of God Hospital, Paracelsus, Salzburg, Austria
| | - Michael J A Parr
- Intensive Care, Liverpool University Hospital, University of New South Wales, Sydney, NSW, Australia; Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
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27
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Kidson KM, Lapinsky S, Grewal J. A Detailed Review of Critical Care Considerations for the Pregnant Cardiac Patient. Can J Cardiol 2021; 37:1979-2000. [PMID: 34534620 DOI: 10.1016/j.cjca.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023] Open
Abstract
Maternal cardiovascular disease is a leading cause of maternal death worldwide and recently, maternal mortality has increased secondary to cardiovascular causes. Maternal admissions to critical care encompass 1%-2% of all critical care admissions, and although not common, the management of the critically ill pregnant patient is complex. Caring for the critically ill pregnant cardiac patient requires integration of pregnancy-associated physiologic changes, understanding pathophysiologic disease states unique to pregnancy, and a multidisciplinary approach to timing around delivery as well as antenatal and postpartum care. Herein we describe cardiorespiratory changes that occur during pregnancy and the differential diagnosis for cardiorespiratory failure in pregnancy. Cardiorespiratory diseases that are either associated or exacerbated by pregnancy are highlighted with emphasis on perturbations secondary to pregnancy and appropriate management strategies. Finally, we describe general management of the pregnant cardiac patient admitted to critical care.
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Affiliation(s)
- Kristen M Kidson
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Stephen Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Grewal
- Division of Cardiology, University of British Columbia, Pacific Adult Congenital Heart Disease Program, St Paul's Hospital, Vancouver, British Columbia, Canada.
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Ching CK, Leong BSH, Nair P, Chan KC, Seow E, Lee F, Heng K, Sewa DW, Lim TW, Chong DTT, Yeo KK, Fong WK, Anantharaman V, Lim SH. Singapore Advanced Cardiac Life Support Guidelines 2021. Singapore Med J 2021; 62:390-403. [PMID: 35001112 PMCID: PMC8804484 DOI: 10.11622/smedj.2021109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Advanced cardiac life support (ACLS) emphasises the use of advanced airway management and ventilation, circulatory support and the appropriate use of drugs in resuscitation, as well as the identification of reversible causes of cardiac arrest. Extracorporeal cardiopulmonary resuscitation and organ donation, as well as special circumstances including drowning, pulmonary embolism and pregnancy are addressed. Resuscitation does not end with ACLS but must continue in post-resuscitation care. ACLS also covers the recognition and management of unstable pre-arrest tachy- and bradydysrhythmias that may deteriorate further.
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Affiliation(s)
- Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Praseetha Nair
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Kim Chai Chan
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Eillyne Seow
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Francis Lee
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Kenneth Heng
- Emergency Medicine Department, Tan Tock Seng Hospital, Singapore
| | - Duu Wen Sewa
- Department of Respiratory Medicine, Singapore General Hospital, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Hospital, Singapore
| | | | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wee Kim Fong
- Department of Anaesthesia, Tan Tock Seng Hospital, Singapore
| | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. [Cardiac arrest under special circumstances]. Notf Rett Med 2021; 24:447-523. [PMID: 34127910 PMCID: PMC8190767 DOI: 10.1007/s10049-021-00891-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 01/10/2023]
Abstract
These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Deutschland
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Tschechien
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Charles University in Prague, Hradec Králové, Tschechien
| | - Anette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife Großbritannien
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Teaching and research Unit, Emergency Territorial Agency ARES 118, Catholic University School of Medicine, Rom, Italien
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spanien
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Köln, Deutschland
| | - Jerry P. Nolan
- Resuscitation Medicine, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, BA1 3NG Bath, Großbritannien
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | - Karl-Christian Thies
- Dep. of Anesthesiology and Critical Care, Bethel Evangelical Hospital, University Medical Center OLW, Bielefeld University, Bielefeld, Deutschland
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
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Oh J, Cha KC, Lee JH, Park S, Kim DH, Lee BK, Park JS, Jung WJ, Lee DK, Roh YI, Kim TY, Chung SP, Kim YM, Park JD, Kim HS, Lee MJ, Na SH, Cho GC, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 4. Adult advanced life support. Clin Exp Emerg Med 2021; 8:S26-S40. [PMID: 34034448 PMCID: PMC8171171 DOI: 10.15441/ceem.21.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Seungmin Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Hyeok Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Keon Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Youn Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation 2021; 161:152-219. [PMID: 33773826 DOI: 10.1016/j.resuscitation.2021.02.011] [Citation(s) in RCA: 331] [Impact Index Per Article: 110.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Catholic University School of Medicine, Teaching and Research Unit, Emergency Territorial Agency ARES 118, Rome, Italy
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spain
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jerry P Nolan
- Resuscitation Medicine, University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, UK
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karl-Christian Thies
- Department of Anesthesiology, Critical Care and Emergency Medicine, Bethel Medical Centre, OWL University Hospitals, Bielefeld University, Germany
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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32
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He F, Li RR, Liu PS, Yang YL, Huang CJ, Chen DJ. Maternal cardiac arrest: a retrospective analysis. BJOG 2021; 128:1200-1205. [PMID: 33314514 DOI: 10.1111/1471-0528.16625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe the characteristics and factors which may influence the maternal outcomes of maternal cardiac arrest (MCA). DESIGN Retrospective analysis of cases. SETTING China. POPULATION OR SAMPLE A total of 61 MCA patients admitted or transferred to The Third Affiliated Hospital of Guangzhou Medical University from January 2000 to December 2019. METHODS Clinical data for MCA were analysed retrospectively. The indicators included maternal age; BMI; gestational age; antenatal examination; income; MCA cause and place; cardiopulmonary resuscitation (CPR); mode of delivery; maternal prognosis; and neonatal outcome. MAIN OUTCOME MEASURES The impact of case characteristics on maternal prognosis of MCA. RESULTS The hospital received 61 patients with MCA, 36 of whom died (mortality 59.0%, 95% CI 46.3-71.7%). MCA was predominantly caused by treatable complications. Those who died were more likely to have collapsed in the ICU. CONCLUSIONS Regular antenatal examination and early intervention can reduce the incidence of adverse pregnancy outcomes. The location of MCA occurred may be related to maternal prognosis. The leading causes of MCA were postpartum haemorrhage and amniotic fluid embolism. TWEETABLE ABSTRACT A retrospective analysis describes the correlation between case characteristics of MCA and maternal outcomes.
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Affiliation(s)
- F He
- Obstetric Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Quality Control Centre of Obstetrics of Guangdong Province, Guangzhou, China
| | - R R Li
- Obstetric Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - P S Liu
- Obstetric Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Y L Yang
- Obstetric Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - C J Huang
- Obstetric Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Obstetric Department, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - D J Chen
- Obstetric Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil
- Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil
- Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil
- Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
- Hospital Barão de Lucena, Recife, PE – Brazil
- Hospital EMCOR, Recife, PE – Brazil
- Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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Leonardsen ACL, Svendsen EJ, Heitmann GB, Dhayyat A, Morris A, Sjøborg KD, Olsen RM, Hardeland C. Development and validation of a questionnaire to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy. PLoS One 2020; 15:e0232984. [PMID: 32396569 PMCID: PMC7217426 DOI: 10.1371/journal.pone.0232984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/24/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancy. METHODS The study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire. RESULTS The expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach's alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts' test of sphericity was greater than the critical value for chi-square, and significant (p < .0001). CONCLUSIONS Findings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.
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Affiliation(s)
- Ann-Chatrin L. Leonardsen
- Department of Health and Welfare, Ostfold University College, Halden, Norway
- Department of Anesthesiology, Ostfold Hospital Trust, Grålum, Norway
| | - Edel J. Svendsen
- Department of Health and Society, University of Oslo, Oslo, Norway
| | | | - Adam Dhayyat
- Department of Medicine, Ostfold Hospital Trust, Grålum, Norway
| | - Ann Morris
- Department of Obstetrics and Gynecology, Ostfold Hospital Trust, Grålum, Norway
| | - Katrine D. Sjøborg
- Department of Obstetrics and Gynecology, Ostfold Hospital Trust, Grålum, Norway
| | - Richard M. Olsen
- Department of Competence Development, Ostfold Hospital Trust, Grålum, Norway
| | - Camilla Hardeland
- Department of Health and Welfare, Ostfold University College, Halden, Norway
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Taylor JEA, Ngua CW, Carwardine M. Massive pulmonary embolism in pregnancy: intra-arrest thrombolysis and resuscitative hysterotomy. BMJ Case Rep 2020; 13:e234083. [PMID: 32327458 PMCID: PMC7202774 DOI: 10.1136/bcr-2019-234083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 11/03/2022] Open
Abstract
Massive pulmonary embolism (PE) is a leading cause of maternal death and may require intra-arrest thrombolysis as well as resuscitative hysterotomy. The case presented is a primigravida in her mid-30s at 28 weeks gestation. The patient presented to the emergency department after out-of-hospital cardiac arrest. Return of spontaneous circulation (ROSC) was achieved but not sustained. Episodic cardiopulmonary resuscitation with epinephrine boluses was required. Resuscitative hysterotomy was performed intra-arrest. Echocardiography revealed a dilated right heart consistent with massive PE and thrombolysis was administered. ROSC was obtained thereafter and output was sustained. Subsequent CT brain revealed irreversible hypoxic injury. Treatment was withdrawn with the support of family. Postmortem examination confirmed massive PE. Thrombolysis can restore and improve cardiovascular status in cardiac arrest caused by massive PE. Thrombolysis is not contraindicated in maternal resuscitation where resuscitative hysterotomy may also be required.
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Affiliation(s)
| | - Chen Wen Ngua
- Emergency Unit, University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Matthew Carwardine
- Anaesthetics, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, UK
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38
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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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Abstract
PURPOSE OF REVIEW The review is intended to serve as a practical clinical aid for the clinician called to maternal cardiac arrest. RECENT FINDINGS Anesthesia complications comprise an important cause of maternal cardiac arrest in developed countries Also predominant are hemorrhage and infections. Recent in-depth reports highlight fractionated care for pregnant women with cardiac and also probably neurological comorbidities. Pathology reports reveal a prevalence of thromboembolic phenomena that is higher than previously assumed but still rare. These are accompanied by particularly high mortality rates. The presenting rhythms of cardiac arrest which differ from most cardiac arrest populations, suggest the need for further in-depth investigation of both the causes and management of these cases. Despite these, outcomes are far better than those of most arrests. Key differences in treatment include are consideration of early airway management and possible medication complications. Pulseless electrical activity and VF should always alert to the possibility of hemorrhage. Echocardiography can diagnose thromboembolism. Also different are the need for Left uterine displacement and early delivery within after 4-5 min of initiation of resuscitation effort in cases with suspected compromise of the venous return or a poor likelihood of a good maternal outcome. SUMMARY Maternal cardiac arrest should be managed similarly to other adult cardiac arrests. At the same time its unique reversible causes require a different form of thought regarding diagnosis and treatment during the code.
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Chen S, Wu L, Jiang X. Aortocaval compression resulting in sudden loss of consciousness and severe bradycardia and hypotension during cesarean section in a patient with subvalvular aortic stenosis. BMC Anesthesiol 2019; 19:116. [PMID: 31272377 PMCID: PMC6610927 DOI: 10.1186/s12871-019-0791-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Maternal cardiac arrest during cesarean section (CS) is an extremely rare but devastating complication. Preventing emergency events from developing into maternal cardiac arrest is one of the most challenging clinical scenarios. Case presentation A 35-year-old pregnant woman with subvalvular aortic stenosis who was scheduled for elective CS under epidural anesthesia, and experienced devastating supine hypotensive syndrome, but was successfully resuscitated after delivery. Conclusions The performance of tilt position strictly or high-quality continue manual left uterine displacement (LUD) should be performed until the fetus is delivered, otherwise timely delivery of the fetus may be the best way to optimize the deadly condition.
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Affiliation(s)
- Shouming Chen
- Department of anesthesiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, The people of south road 20, Chengdu, Sichuan Province, China
| | - Lan Wu
- Department of anesthesiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, The people of south road 20, Chengdu, Sichuan Province, China
| | - Xiaoqin Jiang
- Department of anesthesiology, West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu, 610041, Sichuan province, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, The people of south road 20, Chengdu, Sichuan Province, China.
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Wu SH, Li RS, Hwu YM. Live birth after perimortem cesarean delivery in a 36-year-old out-of-hospital cardiac arrest nulliparous woman. Taiwan J Obstet Gynecol 2019; 58:43-45. [PMID: 30638478 DOI: 10.1016/j.tjog.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The aim of this study is to share a valuable experience of perimortem Cesarean delivery (PMCD) when no signs of spontaneous circulation were detected after 4 min of resuscitation. The time interval between maternal cardiac arrest and neonatal delivery was evaluated and reviewed. CASE REPORT We present the case of an out-of-hospital cardiac arrest (OHCA) in a nulliparous woman who survived a car accident with only seatbelt injuries. The term infant was delivered by PMCD at our emergency department at least 43 min after maternal cardiac arrest. The mother only had concussion and was healthy at the time of discharge. The infant survived but had moderate neurological growth impairment (cerebral palsy) at the age of 7 months. CONCLUSION Contrary to previous studies and case reports, maternal and neonatal outcomes seem to be better when performing PMCD within 10 min. Multidisciplinary teamwork is the key for optimal outcomes in such situations.
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Affiliation(s)
- Szu-Hsin Wu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ryh-Sheng Li
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yuh-Ming Hwu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
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Abstract
Many health care providers lack familiarity with maternal physiologic changes and the distinctive underlying etiology of cardiac arrest in pregnancy. Knowledge of what changes are expected in pregnancy and an understanding of how to adapt clinical practice is essential for the care of the pregnant woman in the emergency department. Amniotic fluid embolism should be recognized as a rare cause of cardiac arrest in pregnancy, characterized by the triad of cardiovascular collapse, hypoxic respiratory failure, and coagulopathy. Cardiopulmonary resuscitation should follow standard AHA ACLS guidelines. Resuscitative hysterotomy may be attempted to restore perfusion to both mother and fetus.
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Affiliation(s)
- Philippa N Soskin
- Department of Emergency Medicine, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Georgetown University School of Medicine, 3800 Reservoir Road Northwest, Ground Floor CCC Building, Washington, DC 20007, USA
| | - Jennifer Yu
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Suite 4B-42, Washington, DC 20010, USA.
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Update: Focus in-hospital maternal cardiac arrest. J Gynecol Obstet Hum Reprod 2019; 48:309-314. [PMID: 30796984 DOI: 10.1016/j.jogoh.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/25/2019] [Accepted: 02/19/2019] [Indexed: 11/21/2022]
Abstract
The incidence of maternal cardiac arrest ranges from 1/55,000 to 1/12,000 births. It is due most frequently to cardiovascular, hemorrhagic, and anesthesia-related causes, as well as to amniotic fluid embolism. The basic principles of resuscitation remain applicable in this situation, but the physiological modifications of pregnancy must be taken into account, in particular, the aortocaval compression syndrome. After 24 weeks of gestation, a salvage cesarean delivery must be performed immediately, without transfer to the operating room, if resuscitation maneuvers have failed 4 min after arrest, because this interval conditions the mother's neurological prognosis and improves neonatal survival.
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Hillman SL, Cooper NC, Siassakos D. Born to survive: A critical review of out-of-hospital maternal cardiac arrests and pre-hospital perimortem caesarean section. Resuscitation 2019; 135:224-225. [PMID: 30599181 DOI: 10.1016/j.resuscitation.2018.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
- S L Hillman
- University College London & University College Hospital, EGA Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom
| | - N C Cooper
- University College London & University College Hospital, EGA Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom
| | - D Siassakos
- University College London & University College Hospital, EGA Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom.
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45
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Maurin O, Lemoine S, Jost D, Lanoë V, Renard A, Travers S, Lapostolle F, Tourtier JP. Maternal out-of-hospital cardiac arrest: A retrospective observational study. Resuscitation 2018; 135:205-211. [PMID: 30562597 DOI: 10.1016/j.resuscitation.2018.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
Abstract
AIM Out-of-hospital cardiac arrests (OHCAs) in pregnant women are rare events. In this study, we aimed to describe a cohort of pregnant women who experienced OHCAs in a large urban area, and received treatment by the prehospital teams in a two-tiered emergency response system. METHODS This retrospective study included pregnant women over 18 years of age who experienced OHCAs. The analysed variables included maternal age, gestational age, variables specific to the rescue system, number of shocks delivered by an automatic external defibrillator, and rates of maternal and neonatal survival. RESULTS Over the 5-year study period, 19,515 OHCAs occurred, 16 of which were in pregnant women. These 16 patients had a median age of 31 years [interquartile range (IQR): 28-35] and a median gestational age of 20 weeks [IQR: 10-33]. Three patients (18.8%) had an initial rhythm of ventricular fibrillation. Only one patient underwent thrombolysis. Of the 16 patients, 6 (38%) died after resuscitation on the scene. The remaining 10 were transported to the hospital, of whom 5 achieved circulation through a mechanical CPR device. Only 2 patients were alive 30days after OHCA. CONCLUSIONS Over half of the pregnant women who experienced OHCA were at least 20 weeks pregnant. Analysis of the prehospital medical data suggests that the current recommendations are difficult to apply in an out-of-hospital environment. Specific recommendations for this situation must be developed.
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Affiliation(s)
- Olga Maurin
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France.
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France; Sudden Death Expertise Center (SDEC), INSERM U970, Paris, France
| | - Vincent Lanoë
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Aurelien Renard
- Military Teaching Hospital, HIA Sainte Anne, Emergency Department, Toulon, France
| | | | - Frederic Lapostolle
- AP-HP, Emergency Medical Service Department (SAMU) 93, Avicenne Hospital, INSERM U942, Bobigny, France
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Lau L, Papanagnou D, Smith E, Waters C, Teixeira E, Zhang XC. A novel biosimulation task trainer for the deliberate practice of resuscitative hysterotomy. Adv Simul (Lond) 2018; 3:19. [PMID: 30305937 PMCID: PMC6172835 DOI: 10.1186/s41077-018-0078-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/18/2018] [Indexed: 11/10/2022] Open
Abstract
Resuscitative hysterotomy is a daunting and rarely performed procedure in the emergency department (ED). Given the paucity of clinical exposure to this intervention, resuscitative hysterotomy is an ideal opportunity for simulation-mediated deliberate practice. The authors propose a novel training program using a homegrown, realistic, simulation device as a means to practice resuscitative hysterotomy. Two high-fidelity, tissue-based task-trainer models were constructed and tested on a convenience sample of 14 emergency medicine (EM) residents. The simulated human placenta, bladder, amniotic sac, and uterus were constructed through the use of porcine skin, porcine stomach, transparent plastic bag, Foley tubing, and squid mantle, all secured with nylon sutures. A Gaumard S500 Articulating Newborn was inserted in the simulated uterus, and the entire model was placed into a Gaumard S500 Childbirth Simulator. Each model required less than 1 h for assembly. Emergent hysterotomy was first demonstrated by an EM faculty facilitator, followed by hands-on deliberate practice. Formal feedback on the learners' self-reported confidence and satisfaction levels was solicited at the end of the workshop through a survey previously cited for use with a low-fidelity resuscitative hysterotomy. Quantitative evaluation of the simulated training session was extracted through a 5-item questionnaire using a 5-point Likert-type scale (i.e., from 1, strongly disagree, to 5, strongly agree). Item scores were added for a cumulative total score, with a possible maximum score of 25 and minimum score of 5. Responses were overwhelmingly positive [24.13 (± 1.36)]. Qualitative feedback was extracted from the survey through open-ended questions; these responses highlighted learners' appreciation for hands-on practice and the development of a novel, tissue-based simulation task trainer. All participants recommended the training session be available to future learners. Resuscitative hysterotomy is a high-stakes, low-frequency procedure that demands provider practice and confidence. Our hybrid, tissue-based hysterotomy model represents a feasible opportunity for training. The model is cost conscious, easily reproducible, and portable and allows for ample deliberate practice.
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Affiliation(s)
- Lawrence Lau
- 1Department of Emergency Medicine, Thomas Jefferson University, 1020 Sansom St., Thompson Bldg, Suite 1651, Philadelphia, PA USA
| | - Dimitrios Papanagnou
- 1Department of Emergency Medicine, Thomas Jefferson University, 1020 Sansom St., Thompson Bldg, Suite 1651, Philadelphia, PA USA.,2Sidney Kimmel Medical School, Thomas Jefferson University, 1020 Sansom St., Thompson Bldg, Suite 239, Philadelphia, PA USA
| | - Elaine Smith
- 1Department of Emergency Medicine, Thomas Jefferson University, 1020 Sansom St., Thompson Bldg, Suite 1651, Philadelphia, PA USA
| | - Crystal Waters
- 3University Clinical Skills and Simulation Center, Thomas Jefferson University, 1001 Locust Street, Suite 409F, Philadelphia, PA USA
| | - Elizabeth Teixeira
- 1Department of Emergency Medicine, Thomas Jefferson University, 1020 Sansom St., Thompson Bldg, Suite 1651, Philadelphia, PA USA
| | - Xiao Chi Zhang
- 1Department of Emergency Medicine, Thomas Jefferson University, 1020 Sansom St., Thompson Bldg, Suite 1651, Philadelphia, PA USA
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Kobori S, Toshimitsu M, Nagaoka S, Yaegashi N, Murotsuki J. Utility and limitations of perimortem cesarean section: A nationwide survey in Japan. J Obstet Gynaecol Res 2018; 45:325-330. [PMID: 30255593 DOI: 10.1111/jog.13819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/29/2018] [Indexed: 11/30/2022]
Abstract
AIM Perimortem cesarean section (PCS) is a procedure performed as part of cardiopulmonary resuscitation (CPR). This study aims to clarify maternal and neonatal prognosis and establish PCS's utility and limitations. METHODS We sent structured questionnaires to obstetrics facilities regarding the cases of PCS performed in Japan between April 2010 and April 2015. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of the time from cardiopulmonary arrest (CPA) to return of spontaneous circulation to predict the onset of disseminated intravascular coagulation (DIC). RESULTS PCS was performed for 18 patients. Out of 18 patients, 12 were resuscitated. The women who were discharged without major sequelae (n = 6) were compared with the non-discharged women who were dead or in persistent vegetative state (n = 12), and median interval time from arrest to PCS was significantly shorter in the former group (P = 0.002). Median interval time from CPA to PCS in the cases in which the neonates survived without major morbidities was significantly shorter than that in the cases of neonatal death and hypoxic encephalopathy (P = 0.01). DIC was observed in 8/9 (89%) patients whose resuscitation took more than 20 min from the diagnosis of CPA. Percutaneous cardiopulmonary support (PCPS) was introduced in 4/9 patients. However, more cases with uncontrolled bleeding, possibly caused by a sudden increase in blood flow and DIC after resuscitation, were observed in the PCPS group compared to the non-PCPS group. CONCLUSION PCS can be an effective CPR procedure. However, if PCS is not performed within 20 min from CPA, starting PCPS before PCS is an option.
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Affiliation(s)
- Shusaku Kobori
- Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Masatake Toshimitsu
- Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Shinichi Nagaoka
- Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, Japan
| | - Jun Murotsuki
- Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan
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Lipowicz AA, Cheskes S, Gray SH, Jeejeebhoy F, Lee J, Scales DC, Zhan C, Morrison LJ. Incidence, outcomes and guideline compliance of out-of-hospital maternal cardiac arrest resuscitations: A population-based cohort study. Resuscitation 2018; 132:127-132. [PMID: 30201534 DOI: 10.1016/j.resuscitation.2018.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/20/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Incidence and survival rates after cardiac arrest among pregnant women are reported for in-hospital cardiac arrests; the incidence and outcomes of maternal out-of-hospital cardiac arrest (OHCA) are unknown. Current cardiopulmonary resuscitation guidelines contain recommendations specific to this population; compliance with these has not been investigated. OBJECTIVE To report maternal OHCA incidence, outcomes, and compliance with recommended treatment guidelines. METHODS A population-based cohort study of consecutive maternal OHCAs from 2010 to 2014. Census data of all women of childbearing age provided the comparison. Resuscitation performance was measured against the 2010 American Heart Association (AHA) Guidelines. RESULTS Six maternal OHCAs were identified among 1085 OHCAs occurring in females of child bearing age (15-49) years; Incidence 1.71 per 100,000 pregnant women (95% CI 0.21 to 6.18) vs. 20.18 OHCAs per 100,000 females of child bearing age (95% CI, 18 to 22.62) p < 0.0001. Survival to hospital discharge was 16.7% (95% CI 3.0, 56.4%) after maternal OHCA vs. 6.8% (95% CI 5.4, 8.4) p < 0.0001 after OHCA in all females of childbearing age, and neonatal survival was 33.3% (95% CI 9.7, 70%). CPR quality metric compliance averaged 83% (range 75% to 100%); compliance with pregnancy-specific resuscitation guidelines ranged from 0% (uterine displacement) to 100% (intravenous line insertion above diaphragm and prehospital maternal team activation). CONCLUSION The incidence of maternal OHCA was 1.71:100,000. Survival was higher after maternal OHCA than after OHCA of non-pregnant females of childbearing age. Pregnancy-specific guideline compliance was low suggesting a need for training and better documentation to improve outcomes in these rare events.
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Affiliation(s)
- Alain A Lipowicz
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sheldon Cheskes
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara H Gray
- Departments of Emergency Medicine and Critical Care, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Farida Jeejeebhoy
- Department of Medicine, University of Toronto, Department of Medicine, William Osler Health System, Toronto, ON, Canada
| | - Janice Lee
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Department of Medicine, William Osler Health System, Toronto, ON, Canada
| | - Damon C Scales
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Cathy Zhan
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Emergency Medicine, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Ng WM, Lee WF, Cheah SO, Chung YEL, Lee CY, Lim BL. Peri-mortem caesarean section after traumatic arrest: Crisis resource management. Am J Emerg Med 2018; 36:2338.e1-2338.e3. [PMID: 30274760 DOI: 10.1016/j.ajem.2018.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022] Open
Abstract
Peri-mortem caesarean section (PMCS) is a very rare procedure performed to improve the chances of survival for both mother and fetus following cardiorespiratory arrest. Non-obstetricians including Emergency Physicians (EPs) are often called upon to perform this procedure under challenging and suboptimal circumstances. We reported a case of PMCS performed timely after traumatic cardiorespiratory arrest that resulted in fetal survival. A 25-year-old primigravida female and six-month pregnant presented to the Emergency Department (ED) of an adult tertiary hospital. She experienced traumatic cardiorespiratory arrest for nearly 27 min following a high-speed motor vehicle crash. Upon ED arrival, she was in pulseless electrical activity. She was immediately intubated with continuation of cardiopulmonary resuscitation. She received bilateral tube thoracostomies as well as intravenous (IV) transfusion of blood products, adrenaline and tranexamic acid. Her fundal height was two centimeters above the umbilicus on palpation. The EP performed a PMCS via a midline laparotomy 3-4 min upon ED arrival. The baby was bradycardic and cyanosed with no spontaneous respiration at birth and was resuscitated by a second EP. She was intubated and the EP gained IV access using a cannula introduced into the umbilical vein. Neonatal hypothermia was avoided using cling wrap. The baby was transported to a nearby neonatal intensive unit. She survived and is currently one year old. The mother, however, did not respond to our resuscitation and succumbed to her multiple injuries. We reviewed the limited literature regarding this potentially life-saving emergency procedure and highlighted the challenges facing our resuscitation team.
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Affiliation(s)
- Wei Ming Ng
- Emergency Department, Ng Teng Fong General Hospital, Singapore.
| | - Wei Feng Lee
- Emergency Department, Ng Teng Fong General Hospital, Singapore
| | - Si Oon Cheah
- Emergency Department, Ng Teng Fong General Hospital, Singapore
| | | | - Chan Yu Lee
- Emergency Department, Ng Teng Fong General Hospital, Singapore
| | - Beng Leong Lim
- Emergency Department, Ng Teng Fong General Hospital, Singapore
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50
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Zelop CM, Einav S, Mhyre JM, Lipman SS, Arafeh J, Shaw RE, Edelson DP, Jeejeebhoy FM. Characteristics and outcomes of maternal cardiac arrest: A descriptive analysis of Get with the guidelines data. Resuscitation 2018; 132:17-20. [PMID: 30170022 DOI: 10.1016/j.resuscitation.2018.08.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/18/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Maternal mortality has risen in the United States in the twenty-first century, yet large cohort data of maternal cardiac arrest (MCA) are limited. OBJECTIVE We sought to describe contemporary characteristics and outcomes of in-hospital MCA. METHODS We queried the American Heart Association's Get with the Guidelines Resuscitation voluntary registry from 2000 to 2016 to identify cases of maternal cardiac arrest. All index cardiac arrests occurring in women aged 18-50 with a patient illness category designated as obstetric or location of arrest occurring in a delivery suite were included. Institutional review deemed that this research was exempt from ethical approval. RESULTS A total of 462 index events met criteria for MCA, with a mean age of 31 ± 7 years and a racial distribution of: 49.4% White, 35.3% Black and 15.3% Other/Unknown. While 32% had no pre-existing conditions or physiologic disorders, respiratory insufficiency (36.1%) and hypotension/hypoperfusion (33.3%) were the most common antecedent conditions. In most cases, the first documented pulseless rhythm was non-shockable; pulseless electrical activity (50.8%) or asystole (25.6%). Only 11.7% presented with a shockable rhythm; ventricular fibrillation (6.5%) or pulseless ventricular tachycardia (5.2%) while the initial pulseless rhythm was unknown in 11.9% of cases. Return of spontaneous circulation occurred in 73.6% but 68 (14.7%) had more than one arrest. The rate of survival to discharge was 40.7% overall; 37.3% with non-shockable rhythms, 33% with shockable rhythms and 64.3% with unknown presenting rhythms. CONCLUSIONS Maternal survival at hospital discharge in this cohort was less than 50%, lower than rates reported in other epidemiological datasets. More research is required in maternal resuscitation science and translational medicine to continue to improve outcomes and understand maternal mortality.
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Affiliation(s)
- Carolyn M Zelop
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Valley Hospital, Ridgewood, NJ, USA; Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA.
| | - Sharon Einav
- Surgical Intensive Care, Shaare Zedek Medical Center, Samuel Byte 12, Jerusalem 9103102, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Jill M Mhyre
- Department of Anesthesiology, University of Arkansas for Medical Sciences, USA.
| | - Steven S Lipman
- Anesthesia Medical Group of Santa Barbara, 514 W. Pueblo St, 2nd floor, Santa Barbara, CA 93105, USA; Adjunct Clinical Faculty of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Julia Arafeh
- Center for Advanced Pediatric and Perinatal Education, Department of Pediatrics, Stanford University School of Medicine, USA.
| | - Richard E Shaw
- Valley Health, Research and Statistical Consultant, The Valley Hospital, 223 N Van Dien Ave, Ridgewood, NJ 07450, USA.
| | - Dana P Edelson
- Rescue Care and Resiliency, The University of Chicago Department of Medicine, 5841 S. Maryland Ave, MC 5000, Chicago, IL 60637, USA.
| | - Farida M Jeejeebhoy
- Division of Cardiology, Dept of Medicine, William Osler Health System, Brampton, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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