The American Heart Association 2010 guidelines for the management of cardiac arrest in pregnancy: consensus recommendations on implementation strategies.

Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 08/2011; 33(8):858-63.
Source: PubMed
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    ABSTRACT: The objective of this analysis was to evaluate the frequency, distribution of potential etiologies, and survival rates of maternal cardiopulmonary arrest during the hospitalization for delivery in the United States. By using data from the Nationwide Inpatient Sample during the years 1998 through 2011, the authors obtained weighted estimates of the number of U.S. hospitalizations for delivery complicated by maternal cardiac arrest. Clinical and demographic risk factors, potential etiologies, and outcomes were identified and compared in women with and without cardiac arrest. The authors tested for temporal trends in the occurrence and survival associated with maternal arrest. Cardiac arrest complicated 1 in 12,000 or 8.5 per 100,000 hospitalizations for delivery (99% CI, 7.7 to 9.3 per 100,000). The most common potential etiologies of arrest included hemorrhage, heart failure, amniotic fluid embolism, and sepsis. Among patients with cardiac arrest, 58.9% of patients (99% CI, 54.8 to 63.0%) survived to hospital discharge. Approximately 1 in 12,000 hospitalizations for delivery is complicated by cardiac arrest, most frequently due to hemorrhage, heart failure, amniotic fluid embolism, or sepsis. Survival depends on the underlying etiology of arrest.
    Anesthesiology 04/2014; 120(4):810-8. DOI:10.1097/ALN.0000000000000159 · 6.17 Impact Factor
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    ABSTRACT: This consensus statement was commissioned in 2012 by the Board of Directors of the Society for Obstetric Anesthesia and Perinatology to improve maternal resuscitation by providing health care providers critical information (including point-of-care checklists) and operational strategies relevant to maternal cardiac arrest. The recommendations in this statement were designed to address the challenges of an actual event by emphasizing health care provider education, behavioral/communication strategies, latent systems errors, and periodic testing of performance. This statement also expands on, interprets, and discusses controversial aspects of material covered in the American Heart Association 2010 guidelines.
    Anesthesia and analgesia 05/2014; 118(5):1003-1016. DOI:10.1213/ANE.0000000000000171 · 3.42 Impact Factor
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    ABSTRACT: Cardiac arrest in pregnancy is a rare but catastrophic obstetric emergency, with a quoted incidence of 1:20,000 pregnancies. Speedy multidisciplinary interventions are crucial for good maternal and foetal outcomes. A perimortem caesarean section (PMCS) initiated within 4 min of onset of cardiac arrest to minimise the effect of aortocaval compression on cardiopulmonary resuscitation (CPR) has been recommended as a key intervention, which is likely to improve survival of both mother and foetus. Sudden collapse is uncommon in pregnant women and their management is more challenging than in a non-pregnant patient. This article aims to emphasise the significance of early identification and management of impending or established maternal cardiac arrest. We propose that a focus on effective and good-quality CPR, utilising key interventions such as early airway control, left uterine displacement and a timely decision for a PMCS with multidisciplinary input is more likely to result in good maternal and foetal survival and neurological outcomes. We also discuss the role of 'fire drill' obstetric training for key staff and the use of a dedicated hospital-wide resuscitation code for managing collapse in obstetric patients in improving survival and outcomes. We present four cases of maternal cardiac arrest managed with PMCS in our hospital, highlighting the evolution in management and with improved outcomes following changes to our resuscitation guidelines, training and workflows.
    Archives of Gynecology and Obstetrics 12/2014; 291(4). DOI:10.1007/s00404-014-3559-z · 1.28 Impact Factor

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