CPR and Pregnancy

Although there is concern for the viability of the unborn child, effective resuscitation of the mother is the best way to optimise fetal outcome

ANZCOR Guideline 11.10: Resuscitation in Special Circumstances (2011)

OVERVIEW

  • Cardiac arrest in pregnancy is rare (1:20,000 pregnancies with out-of-hospital cardiac arrest)

COMMON CAUSES

OF NOTE

  • Physiological changes of pregnancy mean increased: cardiac output, blood volume, minute ventilation, oxygen consumption and reduced lung volumes which complicate the ABCs of resuscitation
  • The gravid uterus compresses the abdominal organs and abdominal vessels (IVC and aorta) when supine
  • Don’t forget that there are two people you are resuscitating, call early for obstetric and neonatal assistance, and consider an early call for extracorporeal CPR (ECPR) — especially as it may take time to activate

ALS MODIFICATIONS

  • Call for obstetrician and neonatologist early
  • Start standard BLS
  • Prepare early for emergency hysterotomy (perimortem caesarean section)
  • If over 20 weeks pregnant or the uterus is palpable above the level of the umbilicus, add a wedge to give left lateral tilt (pillow or knees of chest compression person), aim for 15-30 degrees
    • You may need to manually displace the uterus to the left to remove caval compression
    • A small amount of tilt is better than no tilt
  • Hands in standard position on lower half of the sternum if feasible for chest compressions
  • Consider early intubation (watch for reflux / engorged upper airway)
  • Defibrillation pads in the standard position with standard shock energies
    • Remove CTG prior to defibrillation
  • If over 20 weeks pregnant or the uterus is palpable above the level of the umbilicus and immediate (within 4 mins) resuscitation is not successful, deliver the fetus by emergency hysterotomy aiming for delivery within 5 mins of collapse.
  • Consider ECPR as a rescue therapy if ALS measures are failing

FOAM

References


Cite this article as: James Pearlman and Chris Nickson, "CPR and Pregnancy," In: LITFL - Life in the FastLane, Accessed on March 27, 2023, https://litfl.com/cpr-and-pregnancy/.

Critical Care

Compendium

ICU Advanced Trainee BMedSci [UoN], BMed [UoN], MMed(CritCare) [USyd] from a broadacre farm who found himself in a quaternary metropolitan ICU. Always trying to make medical education more interesting and appropriately targeted; pre-hospital and retrieval curious; passionate about equitable access to healthcare; looking forward to a future life in regional Australia. Student of LITFL.

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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