Successful Use of Therapeutic Hypothermia in a Pregnant Patient

Abstract

1 Survival to hospital admission or discharge is dismal: less than 30% of patients survived to hospital admission and less than 10% survived to discharge, according to data from the Cardiac Arrest Registry (CARE).2 Survival to discharge is driven mainly by neurologic injury, which accounted for two thirds of OHCA deaths in one study.3 Two studies from 2002 4,5 reported significant improvements in the rates of neurologic recovery and subsequent survival following the induction of mild hypothermia in patients who remained comatose upon resuscitation. However, a more recent and larger study suggests that targeted temperature management, rather than the induction of hypothermia, is the fundamental element for neurologic recovery. 6As of 2013, there were 2 reported cases of pregnant patients who underwent therapeutic hypothermia (TH) with a favorable outcome for both mother and fetus.7,8 A 3rd case study reported mixed results, with fetal demise balanced by the survival of the mother after prolonged hospitalization. 9 We report the use of TH in a pregnant patient, with favorable recovery for both mother and fetus. Our case, along with the other published cases, highlights the fact that pregnancy should not be considered an absolute contraindication for TH. Case ReportA 20-year-old previously healthy black woman, 18 weeks pregnant, experienced OHCA while running on a treadmill at a gymnasium. She was down for approximately 5 minutes before cardiopulmonary resuscitation (CPR) was begun upon EMS arrival. The initial rhythm check revealed that the patient was in ventricular fibrillation cardiac arrest. She promptly received 2 defibrillator shocks and experienced return of spontaneous circulation (ROSC) after approximately 8 minutes of resuscitation.

Hipotermia terapéutica posreanimación cardiopulmonar en el posparto inmediato de una paciente atendida en el Hospital de San José, en Bogotá (Colombia) en 2013: reporte de un caso y revisión de la literatura

“…Como se mencionó, se han publicado 6 reportes de casos (13)(14)(15)(16)(17)(18), las características más relevantes de cada uno se presentan en la tabla 1. Rittember et al (13), publicaron el primer caso exitoso de la aplicación de hipotermia terapéutica en el cuidado posparo cardiaco de una paciente de 35 años con embarazo de 13 semanas, por un infarto agudo al miocardio, que culminó con desenlaces favorables tanto para la madre como para el feto.…”

“…Por otra parte, Ocegueda (17) reporta un caso de embolismo de líquido amniótico con paro cardiorrespiratorio prolongado en una gestante de 32 años, con embarazo de 29 semanas, hay pérdida fetal y la madre se somete a hipotermia terapéutica por 60 h, con recalentamiento gradual posterior; la recuperación neurológica fue completa a los seis meses. Oguayo et al (18), publican el cuarto caso de hipotermia terapéutica posparo cardiaco con recuperación neurológica para la madre y desenlace favorable para el feto, y recomiendan considerar este manejo como una intervención en el arresto cardiaco de la paciente gestante. Por otra parte, Suresh et al (19) publicaron una revisión narrativa de paro cardiaco en la mujer parturienta; los autores describen que para mejorar la sobrevida sin déficit neurológico, se debe considerar la hipotermia terapéutica posparo cardiaco con metas de 32/34,8 °C, logradas en las primeras 4-6 h. Recomiendan la monitorización fetal continua en respuesta a la bradicardia fetal reportada en los casos publicados.…”

Maternal hypothermia from environmental exposure in the third trimester

“…Rittbenberg et al initially describe a case where therapeutic hypothermia was used in a patient at 13-week gestation after cardiac arrest, who went on to deliver a healthy infant at term [4]. Other cases have since been published with infant neurodevelopmental outcomes followed up to 36 months and found to be reassuring [6,7]. In most cases, foetal bradycardia was noted with once goal maternal temperature of approximately 33°C was achieved.…”

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

“…Targeted temperature management has not been recognized as a standard therapy for post‐cardiac arrest brain injury during pregnancy. It is not contraindicated for pregnant patients after resuscitation, but has been rarely used, with only four cases reported recently . Although TTM was completed without any maternal complications in all of those cases, one fetal death was documented .…”