At what time point during a maternal code for cardiac arrest would you perform perimortem caesarean?

Wednesday 28th June 2017, 8pm BST

We will be discussing: ‘The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study’ by Beckett and colleagues.

The hosted discussion will take place on Twitter, with the discussion continuing for up to 7 days. Remember to use #BlueJC in all your Tweets!
Host: @bluejchost

Scenario

As the obstetrician in house, you are called to the emergency room to assist in the care of a pregnant patient who is “coding.” Upon arrival, you hear that the patient presented with hypoxia which led to cardiac arrest just moments before your arrival. The emergency medicine team is rapidly performing intubation and has begun chest compressions on the patient whose abdomen appears to indicate that she is full term. No return of spontaneous circulation (ROSC) is achieved after 2 minutes of CPR.

What do you do?

Description of research

Participants: Pregnant and recently-delivered women in the UK who
received basic life support (BLS) for cardiac arrest
Outcomes: Peri-mortem cesarean section, maternal death
Study design: Prospective descriptive study using the UK Obstetric
Surveillance system, a voluntary but widely-used reporting
system
Authors’ conclusion: 25% of cardiac arrests in pregnancy were associated with
anesthesia administration. Prognosis for out-of-hospital arrest
was poor despite rapid use of BLS. Women undergoing prompt
peri-mortem cesarean had better maternal and neonatal
outcomes.

Discussion points

• How did this study design differ from a retrospective chart review?
• What demographic characteristics and management factors were associated with maternal survival in this study?
• Among women who died, what causes of cardiac arrest and mortality were most common?
• List three specific biases inherent in this study’s design that limit the ability to make strong conclusions and recommendations regarding the management of maternal cardiac arrest.
• What conclusions can be drawn from this data about optimal timing of peri-mortem cesarean section?

Suggested reading

1. Mhyre et al. Cardiac arrest during hospitalization for delivery in the United States, 1998-2011. Anesthesiology 2014;120:810-818.
2. Drukker et al. Perimortem cesarean section for maternal and fetal salvage: concise review and protocol. Acta Obstet Gynecol Scand 2014;93:965-972.
3. Katz et al. Perimortem cesarean delivery. Obstet Gynecol 1986;68:571-576.
4. Katz et al. Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol 2005;192:1916-1920.