Elsevier

Resuscitation

Volume 82, Issue 7, July 2011, Pages 801-809
Resuscitation

Review article
Management of cardiac arrest in pregnancy: A systematic review

https://doi.org/10.1016/j.resuscitation.2011.01.028Get rights and content

Abstract

Objective

To describe the consensus on science pertaining to resuscitation of the pregnant patient.

Data sources

EMBASE, Ovid MEDLINE, Evidence Based Reviews, American Heart Association library and bibliographies of selected articles.

Review methods

The following inclusion criteria were used: pregnancy and cardiac arrest out of hospital, pregnancy and cardiac arrest in hospital, cardiovascular, respiratory, fetal survival, and pharmacology as they relate to cardiac arrest and resuscitation. Non-English papers, case reports and reviews were excluded. Studies were selected through an independent review of titles, abstracts and full article. Two reviewers independently graded the methodological quality of selected articles.

Results

1305 articles were identified and 5 were selected for further review. There were no randomized trials and overall the quality of the selected studies was good. Two studies examined chest compressions on a manikin in left lateral tilt from the horizontal and concluded that although feasible with increasing degrees of tilt forcefulness of the chest compressions decreases. The third study observed the transthoracic impedance was not altered during pregnancy. One case series and one retrospective cohort study reviewed perimortem cesarean section. Both reports concluded that perimortem cesarean section is rarely done within the recommended time frame of 5 min after the onset of maternal cardiac arrest.

Conclusions

Usual defibrillation dosages are likely appropriate in pregnancy. Perimortem cesarean section is an intervention which is rarely done within 5 min to optimize maternal salvage from cardiac arrest. Chest compressions in left lateral tilt are less forceful compared to the supine position.

Introduction

Cardiac disease in the United Kingdom is the most common cause of maternal deaths overall based on the 2003–2005 Confidential Enquiries into Maternal and Child Health1 data set which constitutes the largest population based data set on this target population. The number of cardiac deaths during pregnancy has been increasing since 1991.1 Likely contributors to this increase include a rise in the number of women with risk factors for ischemic heart disease1 and an increase in the number of babies born with congenital heart disease that survive to adulthood.2

The incidence of cardiac arrest in pregnancy is reported to be 1:20,000,1 which is an increase from the 1:30,000 reported in the previous enquiry.3 Although these numbers are small, they are higher than the incidence of sudden cardiac death in young athletes, estimated to be 1:200,000.4 Death of an athlete and death during pregnancy are similar in that they both involve young people, however, death during pregnancy involves two lives and attention to this topic has been lacking.

Our objective was to systematically review the literature that may contribute to defining the modifications to advance care life support resuscitation for the pregnant woman based on a consensus of science. To our knowledge the evidence behind the appropriate management of cardiac arrest associated in pregnancy has not been previously systematically reviewed.7

Section snippets

Sources

The literature search was performed using EMBASE (1980–2010 week 10), Ovid MEDLINE (1950–March week 1 2010), all evidence based medicine (EMB) reviews (which include: ACP Journal Club <1991–March 2010>, Cochrane Central Register of Controlled Trials <1st Quarter 2010>, Cochrane Database of Systematic Reviews <1st Quarter 2010>, Cochrane Methodology Register <1st Quarter 2010>, Database of Abstracts of Reviews of Effects <1st Quarter 2010>, Health Technology Assessment <1st Quarter 2010>, NHS

Results

The search strategy initially identified 1305 citations. Assessment of the articles for the stated inclusion and exclusion criteria based on title, abstract or full text resulted in 5 articles being selected for final review (see Fig. 1). The search strategy included pregnancy related topics and although the search strategy attempted to narrow the field to resuscitation related articles only, many citations retrieved had no relevance to resuscitation science or practice. For example, many

Discussion

This systematic review revealed that the management of cardiac arrest associated with pregnancy is an under-developed area of medicine with very little science to guide treatment recommendations. Based on this systematic review, there are no randomized control trials that evaluated different resuscitation techniques versus standard care during cardiac arrest associated with pregnancy.

There are previously published recommendations on optimal resuscitation techniques and important factors to

Conclusions

Usual defibrillation dosages are likely appropriate in pregnancy. Perimortem cesarean section is rarely done within 5 min from cardiac arrest. Maternal and neonatal survival has been documented with the use of perimortem cesarean section; however, there is not enough information about it optimal use. Chest compressions in a left lateral tilt from the horizontal are feasible but less forceful compared to the supine position, and there are good theoretical arguments to use left lateral uterine

Funding

None.

Conflict of interest statement

None.

Acknowledgements

Author contributions: Dr Jeejeebhoy had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Jeejeebhoy, Zelop, Morrison, Windrim.

Acquisition of data: Jeejeebhoy, Zelop, Windrim.

Analysis and interpretation of data: Jeejeebhoy, Zelop, Morrison, Windrim, Dorian and Carvalho.

Drafting of the manuscript: Jeejeebhoy.

Critical revision of the manuscript for important intellectual content:

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    A Spanish translated version of the abstract of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2011.01.028.

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