Ver el código de «Cardiac arrest in pregnancy»

==Background==
*Occurs in ~1 in 30,000 pregnancies<ref>McDonnell, NJ. Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem Caesarean delivery.  Br J Anaesth. (2009)103(3):406-409.</ref>
*Key differences from non-pregnant cardiac arrest<ref>Engels PT, Caddy SC, Jiwa G, Douglas Matheson J. Cardiac arrest in pregnancy and perimortem cesarean delivery: case report and discussion. CJEM. 2011 Nov;13(6):399-403.</ref>:
**Need to remove uterus from IVC (by rolling patient to side or manual lifting of uterus)
***Do not obtain venous access below the diaphragm
**Secure airway immediately
**Non-cardiac cause of arrest is more likely
**[[Resuscitative hysterotomy]] should be performed rapidly (within 4 minutes), and may save both fetus and mother

==Clinical Features==
*[[Cardiac arrest|Cardiopulmonary arrest]] in gravid female.

==Differential Diagnosis==
===Cardiac Arrest in Pregnancy===
''BEAT CHOPS''
*[[hemorrhage|'''B'''leeding]] / [[DIC]]
*'''E'''mbolism - coronary, [[PE|pulmonary]], [[amniotic fluid embolus|amniotic fluid]]
*'''A'''nesthetic complications
*'''T'''one (uTerine aTony)
*'''C'''ardiac disease - [[MI]], [[aortic dissection]], [[peripartum cardiomyopathy|cardiomyopathy]]
*[[hypertensive emergency|'''H'''ypertension]], [[preeclampsia]], [[eclampsia]]
*'''O'''ther - all typical H's and T's
**[[Hypovolemia]]
**[[Hypoxemia]]
**Hydrogen ion (i.e. [[acidosis|acidemia]])
**[[Hypokalemia|Hypo]]/[[hyperkalemia]]
**[[Hypothermia]]
**[[Tension Pneumothorax]]
**[[Pericardial effusion and tamponade|Cardiac tamponade]]
**[[Toxicology (main)|Toxins]]
**[[Pulmonary embolism|Thrombosis, pulmonary]]
**[[Acute coronary syndrome (main)|Thrombosis, coronary]]
*[[Placental abruption|'''P'''lacental abruption]], [[placenta previa]]
*[[Sepsis|'''S'''epsis]]

==Evaluation==
[[File:Bumm 123 lg - Copy.jpg|thumb|Estimated gestational age based on physical exam.]]
*Clinical

{{Fundal height in pregnancy}}

==Management==
*Standard [[ACLS]] management
**Early [[defibrillation]] - use standard energy levels (safe for fetus in maternal arrest)
***Anterior/Posterior pad placement is preferred
***May use AP pads to pace as well
**Give typical adult [[ACLS]] drugs/dosages
**Airway management / Ventilate with 100% FiO2
**Monitor EtCO2
**Ensure [[post cardiac arrest]] care 

===Maternal Modifications===
*[[Resuscitative hysterotomy]] (aka perimortem c-section) if estimated gestational age >24wks (fundus >~4cm above umbilicus)
**Must make decision early, <4min without ROSC
*Manual left uterine displacement
**Displaces uterus to patient's left, relieving aortocaval compression
**May be of concern even if < 20 wks
**Put hands on right side of gravid abdomen, and '''pull upwards towards ceiling''' and '''leftwards'''
**'''OR''' tilt patient 15–30° to left<ref>Campbell TA and Sanson TG. Cardiac arrest and pregnancy. J Emerg Trauma Shock. 2009 Jan-Apr; 2(1): 34–42.</ref>
**Downward force will worse IVC compression
*IVs above diaphragm - avoids IVC which may be compressed
*Administer [[IVF|fluids]] and [[pRBCs|blood]] products
*Anticipate [[difficult airway]] with high risk of aspiration
*If patient receiving IV magnesium prearrest, stop mag and give arrest dose calcium
*Continue [[CPR]], positioning, de-fib, drugs, and fluids during and after C-section
*[[Therapeutic hypothermia]] contraindicated if patient still intrapartum, but may be safe for postpartum cardiac arrest<ref>Song et al. Safely completed therapeutic hypothermia in postpartum cardiac arrest survivors. Am Jour Emer Med. June 2015. Volume 33, Issue 6, Pages 861.e5–861.e6.</ref>

==Disposition==
*Admit (if [[ROSC]] obtained)

==See Also==
*[[Pregnancy (main)]]
*[[Perimortem cesarean delivery]]

==External Links==
*https://first10em.com/cardiac-arrest-in-pregnancy-the-perimortem-cesarean-section/

==References==
<References/>

[[Category:Critical Care]]
[[Category:OBGYN]]