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.
References
Lewis G (2007) The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer 2003–2005. The Seventh Confidential Enquiry into Maternal Deaths in the United Kingdom. CEMACH, London
Mathur D, Sng BL (2013) Perimortem caesarean section: a review of the anaesthetist’s nightmare. Trends Anaesth Crit Care 3(6):327–330. doi:10.1016/j.tacc.2013.05.002
Confidential enquiry into maternal and child health. Why mothers die 2000–2002: the Sixth Report of the Confidential Enquiries into Maternal Death in the United Kingdom (2004). RCOG Press, London
Dijkman A, Huisman CM, Smit M, Schutte JM, Zwart JJ, van Roosmalen JJ, Oepkes D (2010) Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG 117(3):282–287. doi:10.1111/j.1471-0528.2009.02461.x
Hui D, Morrison LJ, Windrim R, Lausman AY, Hawryluck L, Dorian P, Lapinsky SE, Halpern SH, Campbell DM, Hawkins P, Wax RS, Carvalho JC, Dainty KN, Maxwell C, Jeejeebhoy FM (2011) The American Heart Association 2010 guidelines for the management of cardiac arrest in pregnancy: consensus recommendations on implementation strategies. J Obstet Gynaecol Can 33(8):858–863
Einav S, Matot I, Berkenstadt H, Bromiker R, Weiniger CF (2008) A survey of labour ward clinicians’ knowledge of maternal cardiac arrest and resuscitation. Int J Obstet Anesth 17(3):238–242. doi:10.1016/j.ijoa.2008.01.015
Cohen S, Andes L, Carvalho B (2008) Assessment of knowledge regarding cardiopulmonary resuscitation of pregnant women. Int J Obstet Anesth 17(1):20–25
Wilkinson H, Trustees and Medical Advisers (2011) Saving mothers’ lives. Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG: Int J Obstet Gynaecol 118:1–203. doi:10.1111/j.1471-0528.2010.02847.x
Andersen PO, Jensen MK, Lippert A, Ostergaard D (2010) Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams. Resuscitation 81(6):695–702. doi:10.1016/j.resuscitation.2010.01.024
Perkins GD (2007) Simulation in resuscitation training. Resuscitation 73(2):202–211. doi:10.1016/j.resuscitation.2007.01.005
Chamberlain DA, Hazinski MF, European Resuscitation Council, American Heart Association, Heart and Stroke Foundation of Canada, Australia and New Zealand Resuscitation Council, Resuscitation Council of Southern Africa, Consejo Latino-Americano de Resuscitación (2003) Education in resuscitation. Resuscitation 59(1):11–43
Norris EM, Lockey AS (2012) Human factors in resuscitation teaching. Resuscitation 83(4):423–427. doi:10.1016/j.resuscitation.2011.11.001
Smith A, Edwards S, Siassakos D (2012) Effective team training to improve outcomes in maternal collapse and perimortem caesarean section. Resuscitation 83(10):1183–1184. doi:10.1016/j.resuscitation.2012.07.005
Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O’Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A (2011) Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 118(Suppl 1):1–203. doi:10.1111/j.1471-0528.2010.02847.x
Morris S, Stacey M (2003) Resuscitation in pregnancy. BMJ 327(7426):1277–1279. doi:10.1136/bmj.327.7426.1277
Mathur D, Sng BL (2013) Perimortem caesarean section: rethinking the resuscitation codes? J Obstet Anaesth Crit Care 3(1):35–36. doi:10.4103/2249-4472.114289
Lim Y, Shah MK, Tan HM (2005) Evaluation of surgical and anaesthesia response times for crash caesarean sections—an audit of a Singapore hospital. Ann Acad Med Singapore 34(10):606–610
Hunziker S, Tschan F, Semmer NK, Howell MD, Marsch S (2010) Human factors in resuscitation: lessons learned from simulator studies. J Emerg Trauma Shock 3(4):389–394. doi:10.4103/0974-2700.70764
Conflict of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pandian, R., Mathur, M. & Mathur, D. Impact of ‘fire drill’ training and dedicated obstetric resuscitation code in improving fetomaternal outcome following cardiac arrest in a tertiary referral hospital setting in Singapore. Arch Gynecol Obstet 291, 945–949 (2015). https://doi.org/10.1007/s00404-014-3559-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-014-3559-z