Our excellent Critical Care Medicine Mini-Fellowship met last week for our monthly meeting where we actually had an inter-departmental and inter-disciplinary presence to discuss cardiac arrest in the pregnant patient.
We reviewed three articles which I have summarized for you below:
Turns out there aren’t so many randomized control trials on this topic. Reviewed were case series about peri-mortem C sections – turns out they are only done in the recommended initial 5 minutes of arrest <20% of the time. Amazingly, numerous case reports show women had immediate hemodynamic improvement after the procedure. One review reported 12/22! They found higher rates of baby and maternal recovery when the procedure was done within 5 minutes.
Secondly, there is no difference in impedence in the pregnant patient, and the recommendation is to shock at the same Joules as a nonpregnant patient.
Thirdly, they reviewed an interesting complication in pregnant arrest. We all know that the uterus can put pressure on the IVC, decreasing venous return to the heart. So how do you do compressions on a pregnant patient? Too tilted and they slide off, not tilted enough and you worry about IVC compression. And the strength of compressions decreases with the patient tilted! One possible solution is manual displacement of the uterus.
By Dr. Andrew Grock
Special thanks to Dr. Ashika Jain as usual for cooking, hosting, and teaching