Maternal cardiac arrest—Rarely occurs, rarely researched

Abstract

In this edition of ‘Resuscitation’ a systematic review of ‘Cardiac Arrest in Pregnancy’ is published. 1 Jeejeebhoy M. Zelop C. Windrum R. et al. Management of cardiac arrest in pregnancy: a systematic review. Resuscitation. 2011; PubMed Google Scholar The data formed part of the ILCOR 2010 ‘Consensus on Science Treatment and Recommendations’ and contributed to the formation of new 2010 International Resuscitation Guidelines. 2 International Consensus on Cardiopulmonary Resuscitation and Emergency, Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2010; 81S: e1–330. Google Scholar The authors are to be congratulated on collating all the articles on science pertaining to resuscitation of the pregnant patient. Their results clearly show the dearth of good quality research in this area – no randomized trials evaluating the effect of specialized interventions for cardiac arrest associated with pregnancy could be identified. The main areas where the review documented good evidence for providing guideline recommendations pertain to the use of perimortem caesarean section, 3 Katz V. Balderston K. DeFreest M. Perimortem cesarean delivery: were our assumptions correct?. Am J Obstet Gynecol. 2005; 192: 1916-1921 Abstract Full Text Full Text PDF PubMed Scopus (223) Google Scholar , 4 Dijkman A. Hulsman C. Smith M. et al. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training?. BJOG. 2010; 117: 282-287 Crossref PubMed Scopus (140) Google Scholar the optimal position of the pregnant patient for chest compressions 5 Goodwin A. Pearce A. The human wedge. A manoeuvre to relieve aortocaval compression during resuscitation in late pregnancy. Anaesthesia. 1992; 47: 433-434 Crossref PubMed Scopus (55) Google Scholar , 6 Rees G. Willis B. Resuscitation in late pregnancy. Anaesthesia. 1988; 43: 347-349 Crossref PubMed Scopus (127) Google Scholar and a single study demonstrating that transthoracic impedance was not altered significantly during pregnancy. 7 Nanson J. Elcock D. Williams M. Deakin C. Do physiological changes in pregnancy change defibrillation energy requirements?. BJA. 2001; 87: 237-239 Crossref Scopus (88) Google Scholar Much of the science and current recommendations concerning other aspects of successful maternal resuscitation are lacking and guidelines have been extrapolated from non-pregnant patient based research.