Camillus
Critical Thinker
- Joined
- Dec 24, 2003
- Messages
- 483
OK. The resuscitation team follows the currently recommended American Heart Association (AHA) guidelines on Advanced Cardiac Life Support (ACLS),* based on the International Liaison Committee on Resuscitation’s 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR),** the patient survives and this isn’t a story about the science being right. Colour me surprised.
Just in case you’re wondering here is the relevant section of the AHA guidelines on resuscitation in pregnancy. I’ve removed the inline reference numbers to improve readability. The italics are in the original.
*Either accidentally or by design. I hope it’s by design but it doesn’t sound that way unfortunately.
**The next CoSTR document is being released in October next year with new guidelines coming a month or so after that. Don’t expect any big changes.
Just in case you’re wondering here is the relevant section of the AHA guidelines on resuscitation in pregnancy. I’ve removed the inline reference numbers to improve readability. The italics are in the original.
Emergency Hysterotomy (Cesarean Delivery) for the Pregnant Woman in Cardiac Arrest
Maternal Cardiac Arrest Not Immediately Reversed by BLS and ACLS
The resuscitation team leader should consider the need for an emergency hysterotomy (cesarean delivery) protocol as soon as a pregnant woman develops cardiac arrest. The best survival rate for infants >24 to 25 weeks in gestation occurs when the delivery of the infant occurs no more than 5 minutes after the mother’s heart stops beating. This typically requires that the provider begin the hysterotomy about 4 minutes after cardiac arrest.
Emergency hysterotomy is an aggressive procedure. It may seem counterintuitive given that the key to salvage of a potentially viable infant is resuscitation of the mother. But the mother cannot be resuscitated until venous return and aortic output are restored. Delivery of the baby empties the uterus, relieving both the venous obstruction and the aortic compression. The hysterotomy also allows access to the infant so that newborn resuscitation can begin. The critical point to remember is that you will lose both mother and infant if you cannot restore blood flow to the mother’s heart. Note that 4 to 5 minutes is the maximum time rescuers will have to determine if the arrest can be reversed by BLS and ACLS interventions. The rescue team is not required to wait for this time to elapse before initiating emergency hysterotomy. Recent reports document long intervals between an urgent decision for hysterotomy and actual delivery of the infant, far exceeding the obstetrical guideline of 30 minutes.
Establishment of IV access and an advanced airway typically requires several minutes. In most cases the actual cesarean delivery cannot proceed until after administration of IV medications and endotracheal intubation. Resuscitation team leaders should activate the protocol for an emergency cesarean delivery as soon as cardiac arrest is identified in the pregnant woman. By the time the team leader is poised to deliver the baby, IV access has been established, initial medications have been administered, an advanced airway is in place, and the immediate reversibility of the cardiac arrest has been determined.
*Either accidentally or by design. I hope it’s by design but it doesn’t sound that way unfortunately.
**The next CoSTR document is being released in October next year with new guidelines coming a month or so after that. Don’t expect any big changes.
