CARDIAC ARREST IN PREGNANCY

CARDIAC ARREST IN PREGNANCY : 

1 CARDIAC ARREST IN PREGNANCY ANISH JOSHI

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2 1st Modification: Airway Management Jaw Thrust with Cricoid Pressure

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3 Smaller Endotracheal Tube 0.5-1mm smaller ( #7 or #6.5) Short Laryngoscope Handles Equipment for Cricothyrotomy Failed intubation incidence in pregnancy 1:500 general surgical population 1:2000 Advanced Airway & Resuscitation Equipment Needs

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4 2nd Modification: Uterine Displacement No longer commercially available Multiple rescuers needed C. Cardiff Resuscitation Wedge A. Uterine Tilt: manually displace uterus B. “Human Wedge” Back of a chair under victim at 15° to 30° angle.

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5 3rd Modification: Chest Compressions Additional Pressure Deeper Chest Compressions Hand Placement: Mid-Sternum Why? • Chest wall compliance is decreased • Diaphragm is elevated

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6 4th Modification: Emergency Cesarean Within 5 Minutes of Arrest 4 minute rule Maternal Benefits To Rapid Delivery Decrease aortacaval compression Increase in venous return Increase in effectiveness of chest compressions Increase in maternal cardiac output to 25% -33% Fetal Outcome: Viability: >23 weeks gestation Birth weight: >1000 grams Delivery ≤ 5 minutes of arrest

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7 Defibrillation No modifications in dose or pad position. Defibrillation shocks transfer no significant current to the fetus. Remove any electronic fetal or uterine monitors before shock delivery. Differential Diagnoses and Decisions

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8 Airway: Insert advanced airway early to reduce aspiration. Small ET tube ( #6.5 or #7) Watch for excessive bleeding following insertion of any tube into the mouth or nose. Secondary survey An experienced provider should intubate. Preoxygenation; assume rapid hypoxia. Continuous cricoid pressure Circulation: Administration of all resuscitation medications. Do not use the femoral vein or other lower extremity sites for venous access.

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9 Differential Diagnoses and Decisions Decide whether to perform emergency hysterotomy. Identify and treat reversible causes of the arrest. “6 H’s and 6 T’s” Hypovolemia Hypoxia Hydrogen ion (acidemia) Hypo & Hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade, cardiac Tension pneumothorax Thrombosis (coronary or pulmonary) Trauma

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10 Consider causes related to pregnancy Excess MgSO4 Pre-eclampsia/eclampsia Acute coronary syndromes Aortic dissection Pulmonary embolism & stroke Amniotic fluid embolism Trauma and drug overdose

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11 Vasopressor agents such as epinephrine, vasopressin, and dopamine will decrease blood flow to the uterus. There are no alternatives. Use indicated medications in recommended doses. The mother must be resuscitated or the chances of fetal resuscitation vanish.

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12 Thankyou