Short Description

This algorithm outlines the steps for the rescuer to efficiently assess and manage cardiac arrest in a pregnant patient.

Algorithm at a Glance

• The rescuer immediately recognizes cardiac arrest in the pregnant patient and begins high-quality CPR.
• The assembled team must include experts in obstetrics and neonatology in addition to the regular resuscitation team.
• The team determines if the cardiac arrest rhythm is shockable (VF or pVT) or nonshockable (PEA or asystole).
• If the rhythm is shockable, the team administers a shock as soon as a defibrillator is available.
• If the rhythm is not shockable, the team administers epinephrine as early as possible and every 3–5 minutes after that.
• High-quality CPR is continued as long as the patient is in cardiac arrest.
• After 5 minutes without a response, the team considers the need for an emergent cesarean section delivery.
• For VF or pVT, the team leader considers antiarrhythmics if defibrillation is not successful.

Goals for the Management of Cardiac Arrest in Pregnant Patients

The responder must succeed in the following goals to successfully manage cardiac arrest in pregnant patients:

• Recognizing the rhythms of cardiac arrest: ventricular fibrillation, ventricular tachycardia, PEA, and asystole
• Recognizing the Hs and Ts as possible causes of cardiac arrest
• Appropriately intervening in the cardiac arrest, depending on the cardiac arrest rhythm
• Remembering that there are two lives involved in this scenario—both mother and unborn child

The Cardiac Arrest in a Pregnant Patient Algorithm

This algorithm was created to present the steps for assessing and managing pregnant patients presenting with cardiac arrest symptoms.

A pregnant patient experiencing cardiac arrest has two lives at stake.

In-Hospital Cardiac Arrest During Pregnancy Algorithm

Related Video: Procedures for Treating a Choking Pregnant Woman – New 2020 AHA / ILCOR Guidelines

Related Video: Understanding the In-Hospital Cardiac Arrest in Pregnancy Algorithm

Box 1: BLS/ACLS

The team provides high-quality CPR and defibrillation to resuscitate the pregnant patient in cardiac arrest and follows other ACLS interventions as appropriate.

Box 2: Notifying Resuscitation Teams

The critical difference in this resuscitation is that the maternal and neonatal teams are present during the resuscitation to care for the mother and newborn.

Box 3: Determining Etiology of Arrest

During the arrest, the team attempts to identify and treat the cause. 

Possibilities include:

• Anesthesia complications
• Blood loss
• Cardiovascular issues
• Drugs
• Embolus
• Fever
• General causes (Hs and Ts)
• Hypertension

A potential cause for cardiac arrest could be anesthesia complications

Box 4: ACLS Interventions for the Mother

The team provides 100% oxygen to the mother through a patent airway. The most experienced team member obtains and maintains the airway. A skilled member initiates an IV above the level of the mother’s diaphragm. 

If the mother is receiving magnesium, the team discontinues that infusion and administers calcium chloride or calcium gluconate.

Box 5: BLS/ACLS

The team continues to provide high-quality CPR and other ACLS interventions as appropriate.

Box 6: Obstetric Interventions

As team members are providing ACLS interventions, the obstetrics team detaches any fetal monitors, maintains lateral uterine displacement, and prepares for the infant’s delivery by emergent cesarean section.

Box 7: Cesarean Section Delivery

If the mother does not achieve ROSC within 5 minutes, the team leader must consider an immediate emergent cesarean section delivery.

Box 8: Transferring Care of Neonate to Neonatal Team

Following delivery, the neonatal team assumes care of the infant.