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Management of cardiac arrest in pregnancy: A systematic review.
MedLine Citation:
PMID:  21549495     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To describe the consensus on science pertaining to resuscitation of the pregnant patient. DESIGN: Systematic review. DATA SOURCES: EMBASE, Ovid MEDLINE, Evidence Based Reviews, American Heart Association library and bibliographies of selected articles. REVIEW METHODS: The following inclusion criteria were used: pregnancy and cardiac arrest out of hospital, pregnancy and cardiac arrest in hospital, cardiovascular, respiratory, fetal survival, and pharmacology as they relate to cardiac arrest and resuscitation. Non-English papers, case reports and reviews were excluded. Studies were selected through an independent review of titles, abstracts and full article. Two reviewers independently graded the methodological quality of selected articles. RESULTS: 1305 articles were identified and 5 were selected for further review. There were no randomized trials and overall the quality of the selected studies was good. Two studies examined chest compressions on a manikin in left lateral tilt from the horizontal and concluded that although feasible with increasing degrees of tilt forcefulness of the chest compressions decreases. The third study observed the transthoracic impedance was not altered during pregnancy. One case series and one retrospective cohort study reviewed perimortem cesarean section. Both reports concluded that perimortem cesarean section is rarely done within the recommended time frame of 5min after the onset of maternal cardiac arrest. CONCLUSIONS: Usual defibrillation dosages are likely appropriate in pregnancy. Perimortem cesarean section is an intervention which is rarely done within 5min to optimize maternal salvage from cardiac arrest. Chest compressions in left lateral tilt are less forceful compared to the supine position.
Farida M Jeejeebhoy; Carolyn M Zelop; Rory Windrim; Jose C A Carvalho; Paul Dorian; Laurie J Morrison
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-5
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Department of Medicine, University of Toronto, Division of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada.
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