Cardiopulmonary Resuscitation

of the Pregnant Woman in Cardiac Arrest

Dr. dr. Muzakkir Amir, SpJP (K)

Cardiac arrest in PREGNANCY

challenging

2 patients
Mother
Fetus
Hemodynamic Changes during PREGNANCY

Arany Z and Liu LX. Maternal cardiac metabolism in pregancy. Cardiovascular Research 2014;101: 545-53.
 SCOPE OF THE PROBLEM

• US Nationwide Inpatient Sample

 cardiac arrest occurs in 1:12.000 admissions for delivery1

• Globally, 800 maternal deaths occur daily2

1. Mhyre JM, Tsen LC, Einav S, Kuklina EV, Leffert LR, Bateman BT. Cardiac arrest during hospitalization for delivery in the United States, 1998-2011.
Anesthesiology. 2014;120:810-818
2. Centers for Disease Control and Prevention. Pregnancy mortality surveillance system. 2014.
What Should We Do?
Cardiac Arrest in Pregnancy IN-HOSPITAL BLS Algorithm
 Supine pregnant patient

Gravid uterine pressure

Compression of IVC
Left Uterine Displacement (LUD)
↓ Venous return

↓ Cardiac output 10 – 30%

Manual LUD by the 1-handed technique from the RIGHT of the patient
Manual LUD by the 2-handed technique from the LEFT of the patient
Cardiac Arrest in Pregnancy IN-HOSPITAL ACLS Algorithm
Cardiac Arrest in Pregnancy OUT-OF-HOSPITAL BLS Algorithm