In-Hospital Cardiac Arrest in Pregnancy Algorithm
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 non shockable (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
Cardiac Arrest in a Pregnant Patient Algorithm Explained
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.
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.
Related Video – Magnesium: ACLS Medications
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.
Related Video – Understanding Neonatal BLS
More Free Resources to Keep You at Your Best
Editorial Note
ACLS Certification Association (ACA) uses only high-quality medical resources and peer-reviewed studies to support the facts within our articles. Explore our editorial process to learn how our content reflects clinical accuracy and the latest best practices in medicine. As an ACA Authorized Training Center, all content is reviewed for medical accuracy by the ACA Medical Review Board.