Carolyn M Zelop1, Sharon Einav2, Jill M Mhyre3, Steven S Lipman4, Julia Arafeh5, Richard E Shaw6, Dana P Edelson7, Farida M Jeejeebhoy8. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Valley Hospital, Ridgewood, NJ, USA; Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. Electronic address: cmzelop@comcast.net. 2. Surgical Intensive Care, Shaare Zedek Medical Center, Samuel Byte 12, Jerusalem 9103102, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel. Electronic address: einav_s@szmc.org.il. 3. Department of Anesthesiology, University of Arkansas for Medical Sciences, USA. Electronic address: JMMhyre@uams.edu. 4. Anesthesia Medical Group of Santa Barbara, 514 W. Pueblo St, 2nd floor, Santa Barbara, CA 93105, USA; Adjunct Clinical Faculty of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: lipper1@icloud.com. 5. Center for Advanced Pediatric and Perinatal Education, Department of Pediatrics, Stanford University School of Medicine, USA. Electronic address: jarafeh@stanford.edu. 6. Valley Health, Research and Statistical Consultant, The Valley Hospital, 223 N Van Dien Ave, Ridgewood, NJ 07450, USA. Electronic address: shawres@aol.com. 7. Rescue Care and Resiliency, The University of Chicago Department of Medicine, 5841 S. Maryland Ave, MC 5000, Chicago, IL 60637, USA. Electronic address: dperes@bsd.uchicago.edu. 8. Division of Cardiology, Dept of Medicine, William Osler Health System, Brampton, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. Electronic address: Farida.j@sympatico.ca.
Abstract
BACKGROUND: Maternal mortality has risen in the United States in the twenty-first century, yet large cohort data of maternal cardiac arrest (MCA) are limited. OBJECTIVE: We sought to describe contemporary characteristics and outcomes of in-hospital MCA. METHODS: We queried the American Heart Association's Get with the Guidelines Resuscitation voluntary registry from 2000 to 2016 to identify cases of maternal cardiac arrest. All index cardiac arrests occurring in women aged 18-50 with a patient illness category designated as obstetric or location of arrest occurring in a delivery suite were included. Institutional review deemed that this research was exempt from ethical approval. RESULTS: A total of 462 index events met criteria for MCA, with a mean age of 31 ± 7 years and a racial distribution of: 49.4% White, 35.3% Black and 15.3% Other/Unknown. While 32% had no pre-existing conditions or physiologic disorders, respiratory insufficiency (36.1%) and hypotension/hypoperfusion (33.3%) were the most common antecedent conditions. In most cases, the first documented pulseless rhythm was non-shockable; pulseless electrical activity (50.8%) or asystole (25.6%). Only 11.7% presented with a shockable rhythm; ventricular fibrillation (6.5%) or pulseless ventricular tachycardia (5.2%) while the initial pulseless rhythm was unknown in 11.9% of cases. Return of spontaneous circulation occurred in 73.6% but 68 (14.7%) had more than one arrest. The rate of survival to discharge was 40.7% overall; 37.3% with non-shockable rhythms, 33% with shockable rhythms and 64.3% with unknown presenting rhythms. CONCLUSIONS: Maternal survival at hospital discharge in this cohort was less than 50%, lower than rates reported in other epidemiological datasets. More research is required in maternal resuscitation science and translational medicine to continue to improve outcomes and understand maternal mortality.
BACKGROUND: Maternal mortality has risen in the United States in the twenty-first century, yet large cohort data of maternal cardiac arrest (MCA) are limited. OBJECTIVE: We sought to describe contemporary characteristics and outcomes of in-hospital MCA. METHODS: We queried the American Heart Association's Get with the Guidelines Resuscitation voluntary registry from 2000 to 2016 to identify cases of maternal cardiac arrest. All index cardiac arrests occurring in women aged 18-50 with a patient illness category designated as obstetric or location of arrest occurring in a delivery suite were included. Institutional review deemed that this research was exempt from ethical approval. RESULTS: A total of 462 index events met criteria for MCA, with a mean age of 31 ± 7 years and a racial distribution of: 49.4% White, 35.3% Black and 15.3% Other/Unknown. While 32% had no pre-existing conditions or physiologic disorders, respiratory insufficiency (36.1%) and hypotension/hypoperfusion (33.3%) were the most common antecedent conditions. In most cases, the first documented pulseless rhythm was non-shockable; pulseless electrical activity (50.8%) or asystole (25.6%). Only 11.7% presented with a shockable rhythm; ventricular fibrillation (6.5%) or pulseless ventricular tachycardia (5.2%) while the initial pulseless rhythm was unknown in 11.9% of cases. Return of spontaneous circulation occurred in 73.6% but 68 (14.7%) had more than one arrest. The rate of survival to discharge was 40.7% overall; 37.3% with non-shockable rhythms, 33% with shockable rhythms and 64.3% with unknown presenting rhythms. CONCLUSIONS: Maternal survival at hospital discharge in this cohort was less than 50%, lower than rates reported in other epidemiological datasets. More research is required in maternal resuscitation science and translational medicine to continue to improve outcomes and understand maternal mortality.
Authors: Merrill Thomas; Vittal Hejjaji; Yuanyuan Tang; Kevin Kennedy; Anna Grodzinsky; Paul S Chan Journal: Am J Obstet Gynecol Date: 2021-10-22 Impact factor: 10.693