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Maternal cardiac arrest

Helviz, Yigala; Einav, Sharona,b

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 298–306
doi: 10.1097/ACO.0000000000000719

Purpose of review The review is intended to serve as a practical clinical aid for the clinician called to maternal cardiac arrest.

Recent findings Anesthesia complications comprise an important cause of maternal cardiac arrest in developed countries Also predominant are hemorrhage and infections. Recent in-depth reports highlight fractionated care for pregnant women with cardiac and also probably neurological comorbidities. Pathology reports reveal a prevalence of thromboembolic phenomena that is higher than previously assumed but still rare. These are accompanied by particularly high mortality rates. The presenting rhythms of cardiac arrest which differ from most cardiac arrest populations, suggest the need for further in-depth investigation of both the causes and management of these cases. Despite these, outcomes are far better than those of most arrests. Key differences in treatment include are consideration of early airway management and possible medication complications. Pulseless electrical activity and VF should always alert to the possibility of hemorrhage. Echocardiography can diagnose thromboembolism. Also different are the need for Left uterine displacement and early delivery within after 4–5 min of initiation of resuscitation effort in cases with suspected compromise of the venous return or a poor likelihood of a good maternal outcome.

Summary Maternal cardiac arrest should be managed similarly to other adult cardiac arrests. At the same time its unique reversible causes require a different form of thought regarding diagnosis and treatment during the code.

aThe Intensive Care Unit of the Shaare Zedek Medical Center

bThe Hebrew University Faculty of Medicine, Jerusalem, Israel

Correspondence to Yigal Helviz, Shaare Zedek Medical Center Affiliated with the Hebrew University, PO Box 3235, Jerusalem 9103102, Israel. Tel: +972 2 6555564; fax: +972 2 6555846; e-mail:

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