1
|
Nagraj S, Kong S. Maternal cardiac arrest: the present and the future. Future Cardiol 2024; 20:99-101. [PMID: 38923886 PMCID: PMC11216517 DOI: 10.1080/14796678.2024.2341535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/08/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Sanjana Nagraj
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY10467, USA
| | - Steve Kong
- Department of Medicine, NYC Health + Hospitals/North Central Bronx Hospital, Bronx, NY10467, USA
| |
Collapse
|
2
|
Liggett MR, Amro A, Son M, Schwulst S. Management of the Pregnant Trauma Patient: A Systematic Literature Review. J Surg Res 2023; 285:187-196. [PMID: 36689816 DOI: 10.1016/j.jss.2022.11.075] [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: 05/05/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Trauma during pregnancy is the leading cause of non-obstetric maternal death and complicates up to 5%-7% of pregnancies. This systematic review without meta-analysis explores the current literature regarding the assessment and management of pregnant trauma patients to provide evidence-based recommendations to guide the general surgeon regarding the prognostic value of laboratory testing including Kleihauer-Betke testing, duration of maternal and fetal monitoring, the use of tranexamic acid, the safety of radiographic studies, and the utility of perimortem cesarean section to improve maternal and fetal mortality. MATERIALS AND METHODS A systematic search of MEDLINE (Ovid), the Cochrane Library (Wiley), and Embase (Elsevier) was performed. The reference lists of included studies were reviewed for relevant citations. RESULTS Of the 45 studies included in this review, there was reasonable evidence to suggest that the minimally injured pregnant trauma patient should be observed for a minimum of 4 h, CT scans to rule out traumatic injury are necessary and safe, perimortem cesarean sections should be performed as soon as maternal cardiac arrest occurs. CONCLUSIONS We recommend delivery by perimortem cesarean section as soon as possible after maternal cardiac arrest, to provide TXA to the hemorrhaging pregnant trauma patient, to obtain trauma CT scans as indicated, and to observe the injured pregnant patient for a minimum of at least 4 h. Additional high-quality studies focusing on the prognostic potential of KB tests and other laboratory studies are needed.
Collapse
Affiliation(s)
- Marjorie R Liggett
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Ali Amro
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Moeun Son
- Yale University School of Medicine, Obstetrics, Gynecology & Reproductive Sciences, New Haven, Connecticut
| | - Steven Schwulst
- Department of General Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
3
|
Bagou G, Sentilhes L, Mercier FJ, Berveiller P, Blanc J, Cesareo E, Dewandre PY, Douai B, Gloaguen A, Gonzalez M, Le Conte P, Le Gouez A, Madar H, Maisonneuve E, Morau E, Rackelboom T, Rossignol M, Sibiude J, Vaux J, Vivanti A, Goddet S, Rozenberg P, Garnier M, Chauvin A. Guidelines for the management of urgent obstetric situations in emergency medicine, 2022. Anaesth Crit Care Pain Med 2022; 41:101127. [PMID: 35940033 DOI: 10.1016/j.accpm.2022.101127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To provide recommendations on the management of urgent obstetrical emergencies outside the maternity ward. DESIGN A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process, which was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded. METHODS Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. Analysis of the literature and formulation of recommendations were conducted according to the GRADE method. RESULTS Fifteen recommendations on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by the same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all the recommendations. For two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made. CONCLUSIONS There was significant agreement among the experts on strong recommendations to improve practice in the management of urgent obstetric complications in emergency medicine.
Collapse
Affiliation(s)
- Gilles Bagou
- SAMU-SMUR of Lyon, University Hospital Edouard Herriot, Lyon, France.
| | - Loïc Sentilhes
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | - Frédéric J Mercier
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Paul Berveiller
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Julie Blanc
- Gynaecology and Obstetrics Department, University Hospital Hôpital Nord, Marseille, France
| | - Eric Cesareo
- SAMU-SMUR 69, University Hospital Hospices Civils de Lyon, Lyon, France
| | - Pierre-Yves Dewandre
- Department of Anaesthesiology and Critical Care Medicine, University hospital of Liège, Liège, Belgium
| | | | - Aurélie Gloaguen
- Emergency Department, Hospital William Morey, Chalon-sur-Saone, France
| | - Max Gonzalez
- Department of Anaesthesiology and Critical Care Medicine in Gynaecology and Obstetrics, University Hospital Jeanne de Flandre, Lille, France
| | | | - Agnès Le Gouez
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Hugo Madar
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | | | - Estelle Morau
- Department of Anaesthesiology, Critical Care, Pain and Emergency, University hospital Carémeau, Nîmes, France
| | - Thibaut Rackelboom
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Pellegrin, Bordeaux, France
| | - Mathias Rossignol
- University Paris Cité - APHP Nord, Department of Anaesthesiology and Critical Care Medicine, University Hospital Lariboisière, Paris, France
| | - Jeanne Sibiude
- Gynaecology and Obstetrics Department, University Hospital Louis Mourier, Colombes, France
| | - Julien Vaux
- SMUR 94, University Hospital Henri Mondor, Créteil, France
| | - Alexandre Vivanti
- Gynaecology and Obstetrics Department, Antoine Béclère University Hospital, Clamart, France
| | - Sybille Goddet
- SAMU-SMUR 21 and Emergency Department, University Hospital of Dijon, Dijon, France
| | - Patrick Rozenberg
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Marc Garnier
- Sorbonne University, GRC29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Anthony Chauvin
- SAMU-SMUR 75 and Emergency Department, Lariboisière University Hospital, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France
| |
Collapse
|
4
|
Abstract
Simulation is a critical part of training for obstetric emergencies. Incorporation of this training modality has been shown to improve outcomes for patients and is now required by national accrediting organizations.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Bagou G, Sentilhes L, Mercier FJ, Berveiller P, Blanc J, Cesareo E, Dewandre PY, Douay B, Gloaguen A, Gonzalez M, Le Conte P, Le Gouez A, Madar H, Maissonneuve E, Morau E, Rackelboom T, Rossignol M, Sibiude J, Vaux J, Vivanti A, Goddet S, Rozenberg P, Garnier M, Chauvin A. Recommandations de pratiques professionnelles 2022 Prise en charge des urgences obstétricales en médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
7
|
Canon V, Recher M, Lafrance M, Wawrzyniak P, Vilhelm C, Agostinucci JM, Thiriez S, Mansouri N, Morel-Maréchal E, Lagadec S, Leroy A, Vermersch C, Javaudin F, Hubert H. Out-of-hospital cardiac arrest in pregnant women: a 55-patient French cohort study. Resuscitation 2022; 179:189-196. [PMID: 35760226 DOI: 10.1016/j.resuscitation.2022.06.016] [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: 05/09/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
AIM To describe a cohort of pregnant women having suffered an out-of-hospital cardiac arrest (OHCA) and to compare them with nonpregnant women of childbearing age having suffered OHCA. METHODS Study data were extracted from the French National OHCA Registry between 2011 and 2021. We compared patients in terms of characteristics, care and survival. RESULTS We included 3,645 women of childbearing age (15-44) who had suffered an OHCA; 55 of the women were pregnant. Pregnant women were younger than nonpregnant victims (30 vs. 35 years, p=0.006) and were more likely to have a medical history (76.4% vs. 50.5%, p<0.001) and a medical cause of the OHCA (85.5% vs. 57.2%, p<0.001). Advanced Life Support was more frequently administered to pregnant women (98.2%, vs. 72.0%; p<0.001). In pregnant women, the median time of MICU arrival was 20 minutes for the Medical Intensive Care Unit with no difference with nonpregnant women. Survival rate on admission to hospital was higher among pregnant women (43.6% vs. 27.3%; p=0.009). There was no difference in 30-day survival between pregnant and nonpregnant groups (14.5% vs. 7.3%; p=0.061). Fetal survival was only observed for OHCAs that occurred during the pregnancy second or third trimester (survival rates: 10.0% and 23.5%, respectively). CONCLUSIONS Our results show that resuscitation performance does not meet European Resuscitation Council's specific guidelines on OHCA in pregnant women. Although OHCA in pregnancy is rare, the associated prognosis is poor for both woman and fetus. Preventive measures should be reinforced, especially when pregnant women have medical history.
Collapse
Affiliation(s)
- Valentine Canon
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France.
| | - Morgan Recher
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Martin Lafrance
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | - Perrine Wawrzyniak
- French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | - Christian Vilhelm
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | | | | | - Nadia Mansouri
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU94, F-94000 Créteil, France
| | - Emanuel Morel-Maréchal
- SAMU 76, Centre Hospitalier Intercommunal Elbeuf-Louviers-Val de Reuil, F-76503 Saint-Aubin-Lès-Elbeuf, France
| | - Steven Lagadec
- SAMU 91, CH Sud Francilien, F-91100 Corbeil Essonnes, France
| | | | | | - François Javaudin
- Department of Emergency Medicine, Nantes University Medical Center and University of Nantes, Microbiotas Hosts Antibiotics and bacterial Resistances (MiHAR), University of Nantes, Nantes, France
| | - Hervé Hubert
- Univ. Lille Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Électronique des Arrêts Cardiaques), F-59000, Lille, France
| | -
- The members of the study group are listed in the acknowledgment part at the end of the article
| |
Collapse
|
8
|
Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A. Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses. BMC Pregnancy Childbirth 2022; 22:159. [PMID: 35216559 PMCID: PMC8881850 DOI: 10.1186/s12884-021-04334-y] [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] [Received: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations. Results We included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°–30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position. Conclusions Given that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest.
Collapse
Affiliation(s)
- Naosuke Enomoto
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tomoyuki Yamashita
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Edmond S W Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynaecology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | |
Collapse
|
9
|
Improving teamwork in maternity services: a rapid review of interventions. Midwifery 2022; 108:103285. [DOI: 10.1016/j.midw.2022.103285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Gupta S, Pandya S, Jain K, Grewal A, Parikh K, Sharma K, Gupta A, Kasodekar S, Parameswari A, Gogoi D, Raiger L, Rao Ravindra G, Trikha A. The association of obstetric anesthesiologists, India – An expert committee consensus statement and recommendations for the management of maternal cardiac arrest. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_44_22] [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
|
12
|
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
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
R G, Mahalingam S, K A, Goel K, Devendiran A. Pregnancy With Cardiac Arrest in the Emergency Department: Case Report With Review of Literature. Cureus 2021; 13:e14148. [PMID: 33927950 PMCID: PMC8076102 DOI: 10.7759/cureus.14148] [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] [Indexed: 11/05/2022] Open
Abstract
Cardiac arrest in pregnancy is an uncommon encounter, with the incidence being one in every 12,000 hospital admissions for delivery. Here we present, one such patient and our experience in managing the patient. A 23-year-old, third-trimester pregnant female presented with a history of polytrauma following a road traffic accident. On initial assessment, she was in cardiac arrest. We initiated high-quality cardio-pulmonary resuscitation (CPR) as per advanced cardiac life support (ACLS) protocol. We also performed a perimortem cesarean section within four minutes of cardiac arrest. A male baby was delivered who did not have any signs of life. Neonatal resuscitation was initiated. However, both the mother and the child could not be revived. Cardiac arrest in pregnancy is a unique scenario in resuscitation, and all emergency physicians should know the key highlights in managing such patients. We review some existing literature and pose some queries that are yet to be answered.
Collapse
Affiliation(s)
- Gunaseelan R
- Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sasikumar Mahalingam
- Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Aswin K
- Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Kishen Goel
- Emergency Medicine, Apollo Hospitals, Kolkata, IND
| | - Anandhi Devendiran
- Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| |
Collapse
|
15
|
Nyfløt LT, Johansen M, Mulic-Lutvica A, Gissler M, Bødker B, Bremme K, Ellingsen L, Vangen S. The impact of cardiovascular diseases on maternal deaths in the Nordic countries. Acta Obstet Gynecol Scand 2021; 100:1273-1279. [PMID: 33524162 DOI: 10.1111/aogs.14104] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Cardiovascular diseases have become increasingly important as a cause of maternal death in the Nordic countries. This is likely to be associated with a rising incidence of pregnant women with congenital and acquired cardiac diseases. Through audits, we aim to prevent future maternal deaths by identifying causes of death and suboptimal factors in the clinical management. MATERIAL AND METHODS Maternal deaths in the Nordic countries from 2005 to 2017 were identified through linked registers. The national audit groups performed case assessments based on hospital records, classified the cause of death, and evaluated the standards of clinical care provided. Key messages were prepared to improve treatment. RESULTS We identified 227 maternal deaths, giving a maternal mortality rate of 5.98 deaths per 100 000 live births. The most common cause of death was cardiovascular disease (n = 36 deaths). Aortic dissection/rupture, myocardial disease, and ischemic heart disease were the most common diagnoses. In nearly 60% of the cases, the disease was not recognized before death. In more than half of the deaths, substandard care was identified (59%). In 11 deaths (31%), improvements to care that may have made a difference to the outcome were identified. CONCLUSIONS Between 2005 and 2017, cardiovascular diseases were the most common causes of maternal deaths in the Nordic countries. There appears to be a clear potential for a further reduction in these maternal deaths. Increased awareness of cardiac symptoms in pregnant women seems warranted.
Collapse
Affiliation(s)
- Lill T Nyfløt
- Norwegian Research center for Women's Health, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics, Drammen Hospital, Drammen, Norway
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ajlana Mulic-Lutvica
- Institution for Women's and Children's Health, Department for Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Katarina Bremme
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Liv Ellingsen
- Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Siri Vangen
- Norwegian Research center for Women's Health, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
16
|
Ninke T, Bayer A. [Pregnant patients wirsth major trauma in the resuscitation room : Special (patho)physiological and therapeutic aspects]. Unfallchirurg 2020; 123:936-943. [PMID: 33103227 DOI: 10.1007/s00113-020-00901-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Severely injured pregnant women are rarely encountered even in major trauma centers; at the same time high expectations are set for the best possible outcome of mother and child. OBJECTIVE Summary of the main pathophysiological aspects of pregnancy and essential therapeutic implications for emergency room treatment from the perspective of anesthetists. METHODOLOGY Selective literature analysis with a focus on primary physiological literature and the synthesis of pregnancy-adapted recommendations of related guidelines. RESULTS The essential physiological adaptations to pregnancy and their implications for acute care are presented. CONCLUSION Teamwork, structured decision making as well as airway management and goal-oriented hemodynamic treatment are the foundations for a good outcome of mother and child.
Collapse
Affiliation(s)
- T Ninke
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - A Bayer
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| |
Collapse
|
17
|
Hotton EJ, Merialdi M, Crofts JF. Simulation for intrapartum care: from training to novel device innovation. Minerva Obstet Gynecol 2020; 73:82-93. [PMID: 33196635 DOI: 10.23736/s2724-606x.20.04669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarized the many uses of simulation in obstetric emergencies from training to assessment. It also described the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review also discussed novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Cesarean section training. This study analyzed the financial implications of simulation training and how this may impact the delivery of such training packages, considering that simulation should be developed and utilized as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.
Collapse
Affiliation(s)
- Emily J Hotton
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK -
| | | | - Joanna F Crofts
- Department of Women and Children's Research, Southmead Hospital, Translational Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
18
|
Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, Lavonas EJ, Magid DJ. Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S337-S357. [DOI: 10.1161/cir.0000000000000918] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
19
|
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]
|
20
|
O'Dea M, Murphy D, Dubrowski A, Rogers P. Optimizing Perimortem Cesarean Section Outcomes Using Simulation: A Technical Report. Cureus 2020; 12:e10588. [PMID: 33110724 PMCID: PMC7580948 DOI: 10.7759/cureus.10588] [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] [Indexed: 11/21/2022] Open
Abstract
Simulation-based medical education (SBME) is an educational technique that enables participants to experience an immersive representation of a clinical event for the purpose of practice, learning, and evaluation. This experience is intended to improve trainees’ competency and confidence in both procedural tasks, as well as team-based and interpersonal skills when responding to real-world clinical encounters. Moreover, SBME improves procedural exposure and competency in low-frequency, high-stakes clinical procedures without the risk of adverse consequences, error, or patient harm - a priority for physician training at all levels. This technical report describes a novel bi-phasic maternal cardiac arrest simulation that can be used to teach and train post-graduate year one (PGY1) emergency medicine and obstetrics and gynecology trainees in the use of perimortem cesarean sections (PMCS) prior to in-situ exposure. Using a high-fidelity simulation protocol employing training manikins and 3-D printed models of gravid uteri, this bi-phasic simulation, completed over two sessions, six months apart, will equip trainees with the knowledge, skills, and professionalism behaviors necessary for difficult clinical decisions and time-critical procedures.
Collapse
Affiliation(s)
- Maggie O'Dea
- Simulation, Memorial University of Newfoundland, St. John's, CAN
| | - Deanna Murphy
- Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's, CAN
| | | | - Peter Rogers
- Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
| |
Collapse
|
21
|
Moors X, Biesheuvel TH, Cornette J, Van Vledder MG, Veen A, de Quelerij M, Weelink E, Duvekot JJ. Analysis of prehospital perimortem caesarean deliveries performed by Helicopter Emergency Medical Services in the Netherlands and recommendations for the future. Resuscitation 2020; 155:112-118. [PMID: 32745580 DOI: 10.1016/j.resuscitation.2020.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/08/2020] [Accepted: 07/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prehospital perimortem caesarean delivery (PCD) is a rarely performed procedure. In this study, we aimed to examine all PCDs performed by the four Helicopter Emergency Medical Services in the Netherlands; to describe the procedures, outcomes, complications, and compliance with the recommended guidelines; and to formulate recommendations. METHODS We performed a population-based retrospective cohort study of all consecutive maternal out-of-hospital cardiac arrests that underwent PCD in the prehospital setting between May 1995 and December 2019. Registered data included patient demographics, operator background, advanced life support interventions, and timelines. Resuscitation performance was evaluated according to the 2015 European Resuscitation Guidelines. RESULTS Seven patients underwent a prehospital PCD. Three mothers died on the scene, while four were transported to a hospital but died in the hospital. Seven neonates were born by PCD. One neonate died on the scene and six were transported to a hospital. Three neonates were eventually discharged from the hospital. Among the three surviving neonates, the periods from dispatch to start of PCD were 13, 14, and 21 min. CONCLUSIONS There was a low incidence of maternal perimortem caesarean deliveries in The Netherlands. Only some neonates survived after PCD. It is recommended that PCD be performed as quickly as possible. Due to the delay, the mother has a far lower chance of survival than the neonate. In fatal cases, autopsy is strongly recommended.
Collapse
Affiliation(s)
- Xrj Moors
- Department of Anaesthesiology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands; HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - T H Biesheuvel
- Department of Surgery and HEMS, VU University Medical Center, Amsterdam, The Netherlands
| | - J Cornette
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M G Van Vledder
- HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands; Trauma Research Unit, Department of Surgery ErasmusMC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Veen
- HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M de Quelerij
- Department of Anaesthesiology, Franciscus Hospital Rotterdam, The Netherlands
| | - Eem Weelink
- Department of Anaesthesiology and HEMS, University Medical Center Groningen, University of Groningen, The Netherlands
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
22
|
Wang J, Lu J. Anesthesia for Pregnant Women with Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2020; 35:2201-2211. [PMID: 32736999 DOI: 10.1053/j.jvca.2020.06.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
Despite advances in the therapy for pulmonary hypertension over the past decades, the prognosis of pregnant patients with pulmonary hypertension remains poor, with high maternal mortality. This poses a particular challenge for the mother and her medical team. In the present review, the authors have updated the classification and definition of pulmonary hypertension, summarized the current knowledge with regard to perioperative management and anesthesia considerations for these patients, and stressed the importance of a "pregnancy heart team" to improve long-term outcomes of pregnant women with pulmonary hypertension.
Collapse
Affiliation(s)
- Jiawan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing An-Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
|
25
|
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.
Collapse
|
26
|
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.
Collapse
|
27
|
|
28
|
Ameh CA, Mdegela M, White S, van den Broek N. The effectiveness of training in emergency obstetric care: a systematic literature review. Health Policy Plan 2019; 34:257-270. [PMID: 31056670 PMCID: PMC6661541 DOI: 10.1093/heapol/czz028] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes. Weighted means for change in knowledge and skills obtained, narrative synthesis of results for other levels. One hundred and one studies including before-after studies (n = 44) and randomized controlled trials (RCTs) (n = 15). Level 1 and/or 2 was assessed in 68 studies; Level 3 in 51, Level 4 in 21 studies. Only three studies assessed effectiveness at all four levels. Weighted mean scores pre-training, and change after training were 67.0% and 10.6% for knowledge (7750 participants) and 53.1% and 29.8% for skills (6054 participants; 13 studies). There is strong evidence for improved clinical practice (adherence to protocols, resuscitation technique, communication and team work) and improved neonatal outcomes (reduced trauma after shoulder dystocia, reduced number of babies with hypothermia and hypoxia). Evidence for a reduction in the number of cases of post-partum haemorrhage, case fatality rates, stillbirths and institutional maternal mortality is less strong. Short competency-based training in EmOC results in significant improvements in healthcare provider knowledge/skills and change in clinical practice. There is emerging evidence that this results in improved health outcomes.
Collapse
Affiliation(s)
- Charles A Ameh
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sarah White
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| |
Collapse
|
29
|
Schaap TP, Overtoom E, van den Akker T, Zwart JJ, van Roosmalen J, Bloemenkamp KWM. Maternal cardiac arrest in the Netherlands: A nationwide surveillance study. Eur J Obstet Gynecol Reprod Biol 2019; 237:145-150. [PMID: 31051417 DOI: 10.1016/j.ejogrb.2019.04.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Maternal cardiac arrest is a complex and demanding clinical situation requiring a well-attuned team effort of healthcare workers of multiple disciplines. A recent report on maternal cardiac arrest in the United Kingdom reported a rise in incidence over a span of 10 years, while maternal mortality increased in the United States between 2000 and 2014. However, reported causes of maternal cardiac arrest differed between both countries. OBJECTIVE(S) To determine the incidence, causes and management of maternal cardiac arrest in the Netherlands and compare incidence with previous estimates in the Netherlands and the United Kingdom. STUDY DESIGN Using the Netherlands Obstetric Surveillance System, all Dutch cases of maternal cardiac arrest during a three-year period (2013-2016) were prospectively collected. Complete casefile copies were obtained for analysis. Main outcome measures were incidence of maternal cardiac arrest and cardiac arrest in pregnancy, use of perimortem caesarean section if appropriate and maternal death. RESULTS The monthly card return rate was 97%; 18 women with cardiac arrest during pregnancy and 20 postpartum met the inclusion criteria. Incidence of maternal cardiac arrest was 7.6 per 100,000 pregnancies and 3.6 per 100,000 pregnancies excluding postpartum maternal cardiac arrest. Main causes were pulmonary embolism (n = 9), major obstetric hemorrhage (n = 7) and amniotic fluid embolism (n = 6). Aortocaval compression relief and perimortem caesarean section were performed in 9/14 (29%) and 11/14 (79%) respectively in pregnancies 20 weeks gestational age onwards. Twenty-two women died, representing a case fatality rate of 58% (95% CI 42-72%). CONCLUSION(S) There is a higher incidence of cardiac arrest in pregnancy compared to both previous estimates in the Netherlands and recently established figures in the United Kingdom. Main causes of maternal cardiac arrest are potentially preventable and/or treatable complications of pregnancy. Insufficient use of critical elements of obstetric resuscitation identifies the need for enhanced obstetric emergency training for obstetric and non-obstetric first responders.
Collapse
Affiliation(s)
- Timme P Schaap
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Evelien Overtoom
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynaecology, Deventer hospital, Deventer, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands; Athena Institute, VU University, Amsterdam, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, the Netherlands
| |
Collapse
|
30
|
Simulation in Surgical Education: Influences of and Opportunities for the Southern Surgical Association. J Am Coll Surg 2019; 228:317-328. [DOI: 10.1016/j.jamcollsurg.2018.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 01/22/2023]
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
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.
Collapse
|
33
|
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.
| |
Collapse
|
34
|
Tosello B, Blanc J, Kelway C, Pellegrin V, Quarello E, Comte F, Zakarian C, D'Ercole C. [Medical simulation as a tool in the training of perinatal professionals]. ACTA ACUST UNITED AC 2018; 46:530-539. [PMID: 29776841 DOI: 10.1016/j.gofs.2018.04.003] [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: 10/11/2017] [Indexed: 11/29/2022]
Abstract
Though technology plays an increasingly important role in modern health systems, human performance remains a major determinant of safety, effectiveness and efficiency of patient care. This is especially true in the delivery room. Thus, the training of professionals must aim not only for the acquisition of theory and practical skills on an individual basis, but also for the learning of teamwork systematically. Training health professionals with simulation enhances their theoretical knowledge and meets formal requirements in literacy, technical skills and communication. Therefore, we intend to explore how, in perinatal care, training with simulation is actually a key teaching tool in initial education and in perpetuation of knowledge. We will approach three main aspects: individual, collective (team) and the impact of simulation in medical practice. The choice of this educational strategy improves the clinical skills that are required for optimal performance in complex, unpredictable and high-stake environments such as the delivery room. Nonetheless, the long term clinical impact of simulation and whether it's modalities, technical or not, are beneficial to the mother and the newborn are areas still to be explored.
Collapse
Affiliation(s)
- B Tosello
- Service de médecine néonatale, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; UMR 7268 ADÉS, faculté de médecine de marseille, Aix-Marseille université-EFS-CNRS, 51, boulevard Pierre-Dramard, 13344 Marseille cedex 15, France.
| | - J Blanc
- Service de gynécologie-obstétrique, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille université, 13284 Marseille, France
| | - C Kelway
- Service d'anesthésie-réanimation, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - V Pellegrin
- Service d'anesthésie-réanimation, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - E Quarello
- Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France; Unité d'échographie et de diagnostic prénatal, hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex 08, France
| | - F Comte
- École universitaire de Maïeutique Marseille Méditerranée, Aix-Marseille université, boulevard Pierre-Dramard, 13015 Marseille, France
| | - C Zakarian
- École universitaire de Maïeutique Marseille Méditerranée, Aix-Marseille université, boulevard Pierre-Dramard, 13015 Marseille, France
| | - C D'Ercole
- Service de gynécologie-obstétrique, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| |
Collapse
|
35
|
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.
Collapse
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
| | | |
Collapse
|
36
|
Kamei H, Wakimoto Y, Harada K, Fukui A, Tanaka H, Shibahara H. Resuscitative hysterotomy in a patient with peripartum cardiomyopathy. J Obstet Gynaecol Res 2018; 45:724-728. [DOI: 10.1111/jog.13860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Hidetake Kamei
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Japan
| | - Yu Wakimoto
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Japan
| | - Kayoko Harada
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Japan
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Japan
| | - Hiroyuki Tanaka
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology; Hyogo College of Medicine; Nishinomiya Japan
| |
Collapse
|
37
|
Kallianidis AF, Schutte JM, van Roosmalen J, van den Akker T. Maternal mortality after cesarean section in the Netherlands. Eur J Obstet Gynecol Reprod Biol 2018; 229:148-152. [DOI: 10.1016/j.ejogrb.2018.08.586] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/19/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
|
38
|
Comito C, Bechi L, Serena C, Checcucci V, Mori E, Micaglio M, Mecacci F, Petraglia F. Cardiac arrest in the delivery room after spinal anesthesia for cesarean section: a case report and review of literature. J Matern Fetal Neonatal Med 2018; 33:1456-1458. [PMID: 30246574 DOI: 10.1080/14767058.2018.1517321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cardiac arrest in pregnancy is a rare event due to different cause. When it occurs after spinal anesthesia a cause that can explain this event is the Bezold-Jarish Reflex (BJR). A cardiac arrest occurs in a pregnant women after spinal anesthesia admistered for urgent caesarean section. During this event perimortem caesarean delivery (PMCD) is the rapid surgical way that can improve maternal and fetal outcomes. In this situation, it is very important to have a multidisciplinary team of midwives, obstetricians, anesthetists, neonatologists, intensivists that is able to perform perimortem caesarean delivery according to the guidelines.
Collapse
Affiliation(s)
- Chiara Comito
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Lorenzo Bechi
- Department of Maternal Anesthesia, DAIMI, Careggi University Hospital, Florence, Italy
| | - Caterina Serena
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Vanni Checcucci
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Emanuele Mori
- Department of Maternal Anesthesia, DAIMI, Careggi University Hospital, Florence, Italy
| | - Massimo Micaglio
- Department of Maternal Anesthesia, DAIMI, Careggi University Hospital, Florence, Italy
| | - Federico Mecacci
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Maternal-Neonatal Care, DAIMI, Careggi University Hospital, Florence, Italy
| |
Collapse
|
39
|
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.
Collapse
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.
| | | |
Collapse
|
40
|
Zelop CM, Einav S, Mhyre JM, Martin S. Cardiac arrest during pregnancy: ongoing clinical conundrum. Am J Obstet Gynecol 2018; 219:52-61. [PMID: 29305251 DOI: 10.1016/j.ajog.2017.12.232] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/16/2017] [Accepted: 12/27/2017] [Indexed: 02/03/2023]
Abstract
While global maternal mortality has decreased in the last 25 years, the maternal mortality ratio in the United States has actually increased. Maternal mortality is a complex phenomenon involving multifaceted socioeconomic and clinical parameters including inequalities in access to health care, racial and ethnic disparities, maternal comorbidities, and epidemiologic ascertainment bias. Escalating maternal mortality underscores the importance of clinician preparedness to respond to maternal cardiac arrest that may occur in any maternal health care setting. Management of maternal cardiac arrest requires an interdisciplinary team familiar with the physiologic changes of pregnancy and the maternal resuscitation algorithm. Interventions intended to mitigate obstacles such as aortocaval compression, which may undermine the success of resuscitation interventions, must be performed concurrent to standard basic and advanced cardiac life support maneuvers. High-quality chest compressions and oxygenation must be performed along with manual left lateral uterine displacement when the uterine size is ≥20 weeks. While deciphering the etiology of maternal cardiac arrest, diagnoses unique to pregnancy and those of the nonpregnant state should be considered at the same time. If initial basic life support and advanced cardiac life support interventions fail to restore maternal circulation within 4 minutes of cardiac arrest, perimortem delivery is advised provided the uterus is ≥20 weeks' size. Preparations for perimortem delivery are best anticipated by the resuscitation team for the procedure to be executed opportunely. Following delivery, intraabdominal examination may reveal a vascular catastrophe, hematoma, or both. If return of spontaneous circulation has not been achieved, additional interventions may include cardiopulmonary bypass and/or extracorporeal membrane oxygenation. Simulation and team training enhance institution readiness for maternal cardiac arrest. Knowledge gaps are significant in the science of maternal resuscitation. Further research is required to fully optimize: relief of aortocaval compression during the resuscitation process, gestational age and timing of perimortem delivery, and other interventions that deviate from nonpregnant standard resuscitation protocol to achieve successful maternal resuscitation. A robust detailed national and international prospective database was recommended by the International Liaison Committee on Resuscitation in 2015 to facilitate further research unique to cardiac arrest during pregnancy that will produce optimal resuscitation techniques for maternal cardiac arrest.
Collapse
|
41
|
Chu JJ, Hinshaw K, Paterson-Brown S, Johnston T, Matthews M, Webb J, Sharpe P. Perimortem caesarean section - why, when and how. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/tog.12493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Justin J Chu
- Birmingham Women's Hospital; Edgbaston, Birmingham B15 2TG UK
| | - Kim Hinshaw
- City Hospitals Sunderland NHS Foundation Trust; Sunderland SR4 7TP UK
| | | | - Tracey Johnston
- Birmingham Women's Hospital; Edgbaston, Birmingham B15 2TG UK
| | | | - Julian Webb
- Surrey and Sussex Healthcare NHS Trust; East Surrey Hospital; Redhill RH1 5RH UK
| | - Paul Sharpe
- University Hospitals of Leicester NHS Trust; Leicester Royal Infirmary; Leicester LE1 5WW UK
| |
Collapse
|
42
|
Cook DA, Andersen DK, Combes JR, Feldman DL, Sachdeva AK. The value proposition of simulation-based education. Surgery 2018; 163:944-949. [PMID: 29452702 DOI: 10.1016/j.surg.2017.11.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 01/22/2023]
Abstract
Simulation has become an integral part of physician education, and abundant evidence confirms that simulation-based education improves learners' skills and behaviors and is associated with improved patient outcomes. The resources required to implement simulation-based education, however, have led some stakeholders to question the overall value proposition of simulation-based education. This paper summarizes the information from a special panel on this topic and defines research priorities for the field. Future work should focus on both outcomes and costs, with robust measurement of resource investments, provider performance (in both simulation and real settings), patient outcomes, and impact on the health care organization. Increased attention to training practicing clinicians and health care teams is also essential. Clarifying the value proposition of simulation-based education will require a major national effort with funding from multiple sponsors and active engagement of a variety of stakeholders.
Collapse
Affiliation(s)
- David A Cook
- Mayo Clinic Multidisciplinary Simulation Center, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Dana K Andersen
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - John R Combes
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | - David L Feldman
- Hospitals Insurance Company, New York, NY, USA; Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, IL, USA
| |
Collapse
|
43
|
Abstract
Over the last 2 decades, the maternal mortality ratio in the United States has doubled from 7.4/100,000 live births in 1986 to 14.5/100,000 today. Despite great advances in health care, increasing rates of maternal morbidity and mortality in the United States have prompted calls to action to reverse this disturbing trend. Assisted reproductive technology has allowed women to delay childbearing to more advanced ages, resulting in a greater number of pregnancies complicated by one or more of the diseases associated with aging, such as cardiovascular disease, cancer, type 2 diabetes, and hypertension. The obesity epidemic, increasing rates of chronic diseases affecting pregnancy, steadily rising cesarean delivery rate with resulting complications, and medical advances allowing women with rare, but serious diseases to conceive contribute to rising maternal morbidity and mortality rates. Obstetric critical care simulation training may result in improved multidisciplinary teamwork and patient outcomes; and fewer medical and communication errors.
Collapse
Affiliation(s)
- Jean-Ju Sheen
- Department of Obstetrics and Gynecology, Columbia University Medical Center, Morgan Stanley Children's Hospital and Sloane Hospital for Women, New York, NY; NewYork-Presbyterian, Morgan Stanley Children's Hospital and Sloane Hospital for Women, New York, NY
| | - Colleen Lee
- NewYork-Presbyterian, Morgan Stanley Children's Hospital and Sloane Hospital for Women, New York, NY
| | - Dena Goffman
- Department of Obstetrics and Gynecology, Columbia University Medical Center, Morgan Stanley Children's Hospital and Sloane Hospital for Women, New York, NY; NewYork-Presbyterian, Morgan Stanley Children's Hospital and Sloane Hospital for Women, New York, NY.
| |
Collapse
|
44
|
Lee CY, Kung SW. Perimortem caesarean section: A case report of an out-of-hospital arrest pregnant woman. World J Emerg Med 2018; 9:70-72. [PMID: 29290900 PMCID: PMC5717381 DOI: 10.5847/wjem.j.1920-8642.2018.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/26/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Chung-yan Lee
- Accident and Emergency Department, Tseung Kwan O Hospital, Hong Kong, China
| | - Shu-wing Kung
- Accident and Emergency Department, Tseung Kwan O Hospital, Hong Kong, China
| |
Collapse
|
45
|
Cox TR, Crimmins SD, Shannon AM, Atkins KL, Tesoriero R, Malinow AM. Liver lacerations as a complication of CPR during pregnancy. Resuscitation 2017; 122:121-125. [PMID: 29097198 DOI: 10.1016/j.resuscitation.2017.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 11/26/2022]
Abstract
AIM Cardiac arrest in peripartum patients is a rare but devastating event; reported rates in the literature range from 0.019% to 0.0085%. In the general population, a well-described complication of cardiopulmonary resuscitation (CPR), liver laceration and injury, is reported at a rate of between 0.5-2.9% after CPR. Liver laceration rate among peripartum patients receiving CPR has not been well-studied. We sought to find the rate of liver lacerations in the peripartum population associated with CPR, with the hypothesis that the rate would be higher than in the general population. METHODS We identified pregnancies complicated by cardiac arrest by performing a retrospective medical record review from 2011 to 2016 at a single tertiary referral hospital. We then compared the rate of liver lacerations in this group to the rate in the general population as found in the literature. RESULTS Eleven of 9408 women in the peripartum period suffered cardiac arrest. Return of spontaneous circulation occurred in seven of eleven (64%) women. Three of these seven women suffered clinically significant liver laceration (43%). Overall mortality rate among women suffering cardiac arrest was 82% (9/11).Even after return of spontaneous circulation, the mortality rate was 72%(5/7) including two of three women suffering liver laceration. CONCLUSIONS Based on a small retrospective study, liver lacerations requiring intervention occurred in 43% of gravidas patients that survived CPR, and is significantly higher than published rates (0.6-2.1%) for the general patient population. Further studies are indicated to determine the incidence of liver injury after peripartum CPR.
Collapse
Affiliation(s)
- Timothy R Cox
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sarah D Crimmins
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Allison M Shannon
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristin L Atkins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Howard University School of Medicine, Washington, D.C., United States
| | - Ronald Tesoriero
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Andrew M Malinow
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
46
|
Schaap T, Bloemenkamp K, Deneux-Tharaux C, Knight M, Langhoff-Roos J, Sullivan E, van den Akker T. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG 2017; 126:394-401. [PMID: 28755459 DOI: 10.1111/1471-0528.14833] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Develop a core outcome set of international consensus definitions for severe maternal morbidities. DESIGN Electronic Delphi study. SETTING International. POPULATION Eight expert panels. METHODS All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. MAIN OUTCOME MEASURES Definitions with a rate of agreement of more than 70%. RESULTS The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. CONCLUSION Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. TWEETABLE ABSTRACT Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
Collapse
Affiliation(s)
- T Schaap
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - K Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E Sullivan
- Australian Centre for Public and Population Health Research Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - T van den Akker
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | | |
Collapse
|
47
|
Ejima E, Murasato Y. A case of cardiopulmonary arrest due to spontaneous coronary artery dissection in a pregnant woman. BMJ Case Rep 2017; 2017:bcr-2017-220119. [PMID: 28814587 DOI: 10.1136/bcr-2017-220119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a young pregnant woman with cardiopulmonary arrest due to acute coronary syndrome. Emergent coronary angiography (CAG) and intravascular ultrasound (IVUS) showed extensive coronary artery dissection in the left anterior descending artery, which was treated with primary percutaneous coronary intervention. After managing the heart failure and disseminated intravascular coagulation, a dead fetus was delivered via caesarean section 4 days after admission to the hospital. Follow-up CAG and IVUS at 18 months showed persistent dissection in the non-stented site; hence, another stent was implanted. Dual antiplatelet therapy was discontinued 6 months later; however, aspirin and beta-blockers were continued lifelong.
Collapse
Affiliation(s)
- Emiko Ejima
- Division of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yoshinobu Murasato
- Division of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| |
Collapse
|
48
|
Tommila M, Pystynen M, Soukka H, Aydin F, Rantanen M. Two cases of low birth weight infant survival by prehospital emergency hysterotomy. Scand J Trauma Resusc Emerg Med 2017; 25:62. [PMID: 28673308 PMCID: PMC5496320 DOI: 10.1186/s13049-017-0407-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During maternal cardiac arrest, emergency hysterotomy (EH) is recommended after four minutes of resuscitation, if no signs of spontaneous circulation are detected. This extreme procedure is believed to be potentially beneficial for both the mother and the infant. Both maternal and neonatal survivals seem to be associated to the time delay between the cardiac arrest and the delivery and in-hospital resuscitation location. In addition to this, gestational age is an important determinant to neonatal outcome. CASE PRESENTATION We report two emergency hysterotomies executed in an out-of-hospital location. The infants delivered by EH were low birth weight infants and born 20-23 min after maternal cardiac arrest. Both infants survived and had normal physical and neurological growth at the age of two years. Unfortunately, mothers in these both cases died in the field. CONCLUSION Contrary to earlier beliefs, it is possible to perform a successful EH also in out-of-hospital setting, even with incomplete surgical skills. However, training and preparation are extremely important for achieving the highest possible readiness to treat maternal cardiac arrest situations also prehospitally.
Collapse
Affiliation(s)
- Miretta Tommila
- Emergency Medical Services, FinnHEMS 20, University of Turku and Turku University Hospital, Savitehtaankatu 1, Turku, Finland. .,Division of Perioperative Services, Intensive Care Medicine and Pain Management and Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland.
| | - Mikko Pystynen
- Emergency Medical Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Soukka
- Department of Pediatric and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Fatih Aydin
- Emergency Medical Services, FinnHEMS 20, University of Turku and Turku University Hospital, Savitehtaankatu 1, Turku, Finland
| | - Matias Rantanen
- Division of Perioperative Services, Intensive Care Medicine and Pain Management and Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
49
|
|
50
|
Bukar M, Bello M, Pius S, Malgwi A. Post-mortem caesarean section 20 minutes after cardiac arrest with neurologically normal baby at 15 months. J OBSTET GYNAECOL 2017; 37:675-676. [PMID: 28366036 DOI: 10.1080/01443615.2016.1268580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohammed Bukar
- a Department of Obstetrics and Gynaecology , University of Maiduguri Teaching Hospital , Maiduguri , Nigeria
| | - Mustapha Bello
- b Department of Paediatrics , University of Maiduguri Teaching Hospital , Maiduguri , Nigeria
| | - Simon Pius
- b Department of Paediatrics , University of Maiduguri Teaching Hospital , Maiduguri , Nigeria
| | - Adamu Malgwi
- a Department of Obstetrics and Gynaecology , University of Maiduguri Teaching Hospital , Maiduguri , Nigeria
| |
Collapse
|