Cardiopulmonary Resuscitation In Pregnancy Research Articles

Development and validation of a questionnaire to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.

BackgroundCardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancyMethodsThe study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire.ResultsThe expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach’s alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts’ test of sphericity was greater than the critical value for chi-square, and significant (p < .0001).ConclusionsFindings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.

Rare case of diaphragmatic rupture following resuscitation in a pregnant woman first in literature

IntroductionComplications following Cardiopulmonary resuscitation (CPR) are rare and usually follows a vigorous CPR or in special cases like pregnancy are due to lack of knowledge and clinical practice of how to preform CPR in pregnancy. One of this complication is diaphragmatic rupture with herniation of abdominal organs. Surgical intervention needs to be planned carefully in multidisciplinary team approach and requires fine surgical techniques for better outcome. There are few reported cases of diaphragmatic rupture after Cardiopulmonary resuscitation but none in pregnant woman.Case presentationWe report a rare case of diaphragmatic rupture in a 29-year-old pregnant patient who experienced a full-blown diaphragmatic defect and herniation of the abdominal organs into the thoracic cavity, as a complication of CPR. Following careful assessment and diagnosis, the patient underwent urgent laparotomy with reduction of the contents and primary closure of the defect. One year follow up was satisfactory. To the best of our knowledge, this is the first reported case of diaphragmatic rupture with herniation of the abdominal organs following CPR in a pregnant woman in the literature.ConclusionThe application of external cardiac massage through CPR is a life-saving procedure for the management of cardiac arrest. Common complications related to CPR include rib fractures, sternal fractures and haemothorax. Diaphragmatic rupture with herniation of the abdominal organs is a rare complication, having been reported only once in the literature (Sabzi F, Faraji R, Tanaffos 16:170–172, 2017); however, it represents a serious and life-threating event. Thus, careful evaluation of the patient by a multidisciplinary team and prompt intervention is recommended in order to improve outcomes.

Safe Motherhood after Cardiopulmonary Resuscitation in a Term Pregnancy with Eclampsia: A Maternal Near Miss

Cardiac arrest in a term pregnancy is rare with a survival rate of 15-20% and mortality rate as high as 42%. Eclampsia, amniotic fluid embolism, haemorrhagic shock, sepsis, pulmonary thromboembolic events, and anaesthetic complications are significant causes of cardiac arrest. We report a rarest case of a young 26-year-old unbooked primigravida, 38+4 weeks gestation with eclampsia, HELLP syndrome, thrombocytopenia with sudden cardiac arrest-A Maternal Near Miss. Prompt resuscitation with obstetric, and anaesthetist specialist team, paved the journey to safe motherhood. An emergency Lower Segment Caesarean Section (LSCS) immediately after Cardiopulmonary Resuscitation (CPR) was performed. Ventilator support was continued for 72 hours. Successful CPR and immediate caesarean section paved the way to safe motherhood with discharge of healthy mother and baby on 12th post LSCS day. With increasing trends towards high-risk pregnancy and maternal near miss cases, a thorough knowledge in the management of cardiac arrest in pregnancy with advanced resuscitation skills among obstetricians, anaesthetists, and nursing staff is need of the millennium. Repeated simulation learning and mock drills in CPR in pregnancy should be advocated.

General Management Principles of the Pregnant Woman

Pregnancy is a dynamic process that consists of profound physiological changes mediated by hormonal, mechanical, and circulatory pathways. Understanding of changes in physiology is essential for distinguishing abnormal and normal signs and symptoms in a pregnant patient. These physiological changes also have important pharmacotherapeutic considerations for a pregnant patient. Although there are limited data to guide decisions regarding medications and diagnostic procedures in pregnancy, a careful review of risks should be balanced with review of risk of withholding a medication or procedure. Interventional pulmonary procedures can be safely performed in pregnant women while keeping in mind the maternal anatomic and physiologic changes. Furthermore, management of a maternal cardiopulmonary arrest requires important modifications in patient positioning and intravenous access to ensure adequate efficacy of chest compressions, circulation, and airway management. This review will provide an overview of maternal physiologic changes with a focus on cardiopulmonary physiology, pharmacotherapeutic considerations, diagnostic and interventional pulmonary procedures during pregnancy, and cardiopulmonary resuscitation in pregnancy.

MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation

The purpose of this study was to determine, with the use of cardiac magnetic resonance imaging, whether there is vertical displacement of the heart during pregnancy. Cardiopulmonary resuscitation guidelines during pregnancy recommend placing the hands 2-3 cm higher on the sternum than in nonpregnant individuals. This recommendation is based on the presumption that the heart is displaced superiorly by the diaphragm during the third trimester. Whether there is true cardiac displacement because of the expanding uterus in pregnancy remains unknown. A total of 34 healthy female volunteers 18-35 years old were enrolled prospectively from 2010-2012 at 2 tertiary care centers. The conditions of all participants were evaluated with cardiac magnetic resonance imaging in the one-half left lateral decubitus position during the third trimester of pregnancy and again at a minimum of 3 months after delivery (surrogate for the nonpregnant state). Superior displacement of the heart was determined by measurement of the distance between the inferior aspect of the clavicular heads and the coronary sinus at both time points. The study population included 34 women (mean age, 29 ± 3 years; body mass index, 24 ± 4 kg/m(2)). The mean gestational age at third-trimester imaging was 237 ± 16 days (34 weeks ± 16 days); the mean number of days for postpartum imaging (baseline) was 107 ± 25 days (16 weeks ± 25 days). There was no statistical difference between the cardiac position at baseline (10.1 ± 1.2 cm) and during the third trimester (10.3 ± 1.1 cm; P = .22). Contrary to popular assumption, there is no significant vertical displacement of the heart in the third trimester of pregnancy relative to the nonpregnant state. Accordingly, there is no need to alter hand placement for chest compressions during cardiopulmonary resuscitation in pregnancy.

Cardiopulmonary resuscitation of pregnant women in the emergency department

AimLittle is known about outcomes of cardiopulmonary resuscitation (CPR) in pregnancy. The purpose of this study was to determine the prognostic value of pregnancy in women receiving CPR in the emergency department (ED). MethodsWe conducted a population-based, matched cohort study using the Nationwide Emergency Department Sample (NEDS) from 2006 to 2010. A cohort of pregnant women receiving CPR in the ED was compared to an age-matched cohort of non-pregnant women at a 1:10 ratio. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables of interest and survival. ResultsAmong 8162 women requiring CPR in the ED, we identified 157 pregnant women. Pregnancy was associated with better overall survival of 36.9% compared to 25.9% in non-pregnant women, OR 1.89 (1.32–2.70), p<0.01. Traumatic injury was identified as a significant predictor of outcome in pregnancy. In non-trauma patients, pregnant women had significantly better odds of surviving CPR than non-pregnant women, OR 2.10 (1.41–3.13), p<0.01. In cases of trauma, no significant difference was observed between groups. ConclusionAlthough further studies are needed, CPR in pregnancy is associated with a better prognosis compared to non-pregnant women, with trauma status being a key factor predicting outcome in the pregnant patient.

Successful Cardiopulmonary Resuscitation in Pregnancy: A Case Report

The management of cardiac arrest in pregnancy is an important task for the emergency physicians. The clinical outcome of mother or fetus will often depend on the successful resuscitation of the first few minutes. Furthermore, the resuscitation team leader should consider the necessity of emergency hysterotomy (cesarean delivery) as soon as a pregnant woman develops cardiac arrest. We report a case of a 28-year-old pregnant woman who had a ventricular fibrillation cardiac arrest. She was successfully resuscitated in our emergency department and a single male healthy infant was delivered via cesarean section at 36 weeks’ gestation. Mother and baby were discharged survival and neurologically intact from the intensive care unit (ICU) on day 25. We emphasize that understanding the causes of cardiac arrest during pregnancy, its early recognition and prompt resuscitation by recent ACLS guidelines may decrease both maternal and fetal morbidity or mortality.KeywordsCardiac arrest; Cardiopulmonary resuscitation; Cesarean delivery; Fetus; Pregnant

Management of Medical Emergencies in Pregnancy

Medical emergencies in pregnant women pose many challenges if both the baby and mother are to have an optimal outcome. Multidisciplinary team working is essential to ensure that the correct treatment is offered, and that potentially lifesaving options are not discarded because of unwarranted concerns about safety in pregnancy. Expertise should be sought from doctors with a special interest in obstetric medicine. Clinical problems include those unique to pregnancy such as eclampsia or acute fatty liver of pregnancy, exacerbations of chronic medical diseases some of which can be predicted such as pulmonary hypertension, or conditions which have an increased frequency in pregnancy including thromboembolism, urinary tract infection and Bell’s palsy. Cardiopulmonary resuscitation in pregnancy should be managed in the left lateral position, with early recourse to delivery of the fetus.

Cardiopulmonary Resuscitation in Pregnancy

Cardiopulmonary Resuscitation in Pregnancy