Successful treatment of pulmonary embolism‐induced cardiac arrest by thrombolysis and targeted temperature management during pregnancy

Oami, Takehiko; Oshima, Taku; Oku, Reiko; Nakanishi, Koji

doi:10.1002/ams2.345

Cited by 10 publications

(5 citation statements)

References 18 publications

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“…Placental growth factor (PlGF) concentrations and increased salt-1 concentrations [ 24 ]. We examined the plausibility of TTM for treating post-cardiac arrest brain injury in pregnant women as well as the efficacy of tPA for treating substantial pulmonary embolism (PE) that causes cardiac arrest [ 25 ]. Patients with neurocritical illnesses frequently experience seizures and enter status epilepticus (SE).…”

Section: Reviewmentioning

confidence: 99%

Cardiopulmonary Arrest During Pregnancy: A Review Article

Pawar¹,

Anjankar²,

Anjankar³

et al. 2023

Cureus

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Massive pulmonary embolism (PE) is an uncommon but severe complication of pregnancy or during the first few weeks after giving birth. Our intention was to thoroughly analyze the information available to its management methods. Significant bleeding of mother survival and early deliveries in fetal survivals were having hemorrhage and were having key outcomes. We found 127 severe PE cases that have had at least one form of treatment (at least 83% big; 23% with cardiac arrest). The 83 women who received thrombolysis had a 94% (95%) survival rate. Cardiac arrest in pregnancy is uncommon, although maintaining current competency can be challenging. While maternal mortality rates have decreased globally over the past 25 years, they have increased in the United States. The intricacy of the maternal mortality issue is a result of a number of clinical and socioeconomic problems such as unequal healthcare access, racial and ethnic disparities, maternal comorbidities, and bias in epidemiologic ascertainment. The importance of doctors being prepared to react to a potential maternal cardiac arrest in any situation where they are providing treatment for pregnant women is highlighted by the rise in maternal mortality. For the treatment of maternal cardiac arrest, an interdisciplinary team with expertise in both the maternal resuscitation procedure and the physiological changes that take place during pregnancy is necessary. Additionally offered are basic and advanced cardiac life support protocols. Techniques to remove obstacles like aortocaval compression that could impair the effectiveness of resuscitation should be used.

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Section: Reviewmentioning

confidence: 99%

Cardiopulmonary Arrest During Pregnancy: A Review Article

Pawar¹,

Anjankar²,

Anjankar³

et al. 2023

Cureus

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“…As there were only two case reports of TTM use in maternal cardiac arrest at the time of publication [44,45] and lingering concerns for bleeding because of impaired systemic coagulation, the 2015 AHA statement recommended using post-arrest cooling on an individualized basis, and, if used, follow the same current protocol as for non-pregnant) [3]. Recently, several case reports noted using post-arrest TTM in the setting of maternal cardiac arrest with favorable maternal outcomes [5,[46][47][48][49][50][51]. This mounting evidence bolsters the current AHA position supporting the use of post-arrest TTM on an individual basis in pregnancy, with particular focus on the potential for bleeding complications during TTM.…”

Section: Targeted Temperature Management Recommendationsmentioning

confidence: 99%

A modified Delphi approach to determine current treatment advances for the development of a resuscitation program for maternal cardiac arrest

et al. 2022

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Objective Maternal cardiac arrest is a rare and complex process requiring pregnancy-specific responses and techniques. The goals of this study were to (1) identify, evaluate, and determine the most current best practices to treat this patient population and (2) establish a standardized set of guidelines to serve as a foundation for a future educational simulation-based curriculum. Study design We used a three-step modified Delphi process to achieve consensus. Twenty-two healthcare experts from across North America agreed to participate in the expert panel. In round 1, 12 pregnancy-specific best practice statements were distributed to the expert panel. Panelists anonymously ranked these using a 7-point Likert scale and provided feedback. Round 2 consisted of a face-to-face consensus meeting where statements that had not already achieved consensus were discussed and then subsequently voted upon by the panelists. Results Through two rounds, we achieved consensus on nine evidence-based pregnancy-specific techniques to optimize response to maternal cardiac arrest. Round one resulted in one of the 12 best practice statements achieving consensus. Round two resulted in six of the remaining 12 gaining consensus. Best practice techniques involved use of point-of care ultrasound, resuscitative cesarean delivery, cardiopulmonary resuscitation techniques, and the use of extracorporeal cardiopulmonary resuscitation. Conclusion The results of this study provide the foundation to develop an optimal, long-term strategy to treat cardiac arrest in pregnancy. We propose these nine priorities for standard practice, curricula, and guidelines to treat maternal cardiac arrest and hope they serve as a foundation for a future educational curriculum.

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“…17 Massive PE is usually fatal though there have been few reports of successful use of fibrinolytics for massive, life-threatening PE. 18 • Amniotic fluid embolism (AFE): The most feared and deadly cause of arrest in parturient is AFE. There are reports of high morbidity and mortality rates with the condition.…”

Section: Noncardiac Diseasesmentioning

confidence: 99%

Challenges of Cardiopulmonary Resuscitation during Pregnancy

2019

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Cardiac arrest, though rare, is the most feared complication in the pregnant woman as it involves two lives. Most arrests occur because of conditions that result from the pregnancy itself or from preexisting medical conditions exacerbated by the pregnancy. Prompt resuscitative efforts are crucial for favorable outcomes for the mother and fetus. The basic principles of resuscitation during pregnancy such as airway, breathing, and circulation are similar to the resuscitation in a cardiopulmonary arrest in any patient; however, certain modifications are necessary to account for the physiologic changes that occur during the pregnancy. Cardiopulmonary resuscitation (CPR) of the parturient should include uterine tilt or displacement to relieve the compression of the inferior vena cava and aorta by the gravid uterus, intubation using rapid sequence intubation with cricoid pressure, and timely perimortem cesarean section (PMCS). Ideally, the PMCS must be performed within 5 minutes of cardiac arrest if the pregnant woman does not have a return of spontaneous circulation, and resuscitation is deemed unsuccessful. The PMCS is performed if the gestational age is at least 20 weeks or the gravid uterus is evident. A high-quality CPR and multispecialty team approach, consisting of obstetricians, cardiologists, anesthesiologists, neonatologists, and nursing staff, is essential for survival.

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Successful treatment of pulmonary embolism‐induced cardiac arrest by thrombolysis and targeted temperature management during pregnancy

Cited by 10 publications

References 18 publications

Cardiopulmonary Arrest During Pregnancy: A Review Article

Cardiopulmonary Arrest During Pregnancy: A Review Article

A modified Delphi approach to determine current treatment advances for the development of a resuscitation program for maternal cardiac arrest

Challenges of Cardiopulmonary Resuscitation during Pregnancy

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