Cardiac disease in pregnancy resuscitation strategies: Difference between revisions
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{{Cardiac disease in pregnancy}} | {{Cardiac disease in pregnancy}} | ||
{{CMG}}; {{AOEIC}} {{CZ}} | {{CMG}}; {{AOEIC}} {{CZ}} | ||
== | ==Overview== | ||
[[Cardiac arrest]] occurs in approximately one in 30,000 women in late pregnancy.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> Maternal mortality is caused by [[venous thromboembolism]], severe [[preeclampsia]] or [[eclampsia]], [[sepsis]], [[embolism|amniotic fluid embolism]], [[haemorrhage]], [[trauma]], iatrogenic causes including anaesthesia and drug errors or allergy, and congenital or acquired heart disease.<ref name="pmid15388200">{{cite journal |author=Mallampalli A, Powner DJ, Gardner MO |title=Cardiopulmonary resuscitation and somatic support of the pregnant patient |journal=[[Critical Care Clinics]] |volume=20 |issue=4 |pages=747–61, x |year=2004 |month=October |pmid=15388200 |doi=10.1016/j.ccc.2004.05.005 |url=http://linkinghub.elsevier.com/retrieve/pii/S0749-0704(04)00050-8 |accessdate=2012-04-16}}</ref> | [[Cardiac arrest]] occurs in approximately one in 30,000 women in late pregnancy.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> Maternal mortality is caused by [[venous thromboembolism]], severe [[preeclampsia]] or [[eclampsia]], [[sepsis]], [[embolism|amniotic fluid embolism]], [[haemorrhage]], [[trauma]], iatrogenic causes including anaesthesia and drug errors or allergy, and congenital or acquired heart disease.<ref name="pmid15388200">{{cite journal |author=Mallampalli A, Powner DJ, Gardner MO |title=Cardiopulmonary resuscitation and somatic support of the pregnant patient |journal=[[Critical Care Clinics]] |volume=20 |issue=4 |pages=747–61, x |year=2004 |month=October |pmid=15388200 |doi=10.1016/j.ccc.2004.05.005 |url=http://linkinghub.elsevier.com/retrieve/pii/S0749-0704(04)00050-8 |accessdate=2012-04-16}}</ref> | ||
Urgent [[hysterotomy]] or [[Caesarean section]] should be considered in the pregnant woman who has a [[cardiac arrest]]. If early resuscitation fails, birth of the fetus may improve both the maternal and the fetal chances of survival. Infants over 24-25 weeks gestation have the best chance of survival if birthed within 5 minutes of maternal [[cardiac arrest]]. It is recommended that hysterotomy or Caesarean section be initiated within 4 minutes after a cardiac arrest unless there has been a successful resuscitation and maternal perfusion restored within that time.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | |||
==Resuscitation Strategies== | |||
===Position of the Pregnant Women=== | |||
==Position of the | |||
* Position the women on her back with the shoulders flat. Place padding/wedge under the right buttock to give an obvious pelvic tilt to the left.<ref>Australian Resuscitation Council. Guideline 7 Cardiopulmonary resuscitation. In: Australian Resuscitation Council Guidelines; 2006.</ref> | * Position the women on her back with the shoulders flat. Place padding/wedge under the right buttock to give an obvious pelvic tilt to the left.<ref>Australian Resuscitation Council. Guideline 7 Cardiopulmonary resuscitation. In: Australian Resuscitation Council Guidelines; 2006.</ref> | ||
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* An assistant may move the uterus further off the vena cava by lifting the uterus with two hands to the left and towards the woman’s head.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | * An assistant may move the uterus further off the vena cava by lifting the uterus with two hands to the left and towards the woman’s head.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | ||
==Airway | ===Airway Management=== | ||
* The woman should be inclined laterally for suction, removing ill-fitting dentures or foreign bodies, and inserting airways.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | * The woman should be inclined laterally for suction, removing ill-fitting dentures or foreign bodies, and inserting airways.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | ||
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* Mouth to mouth or bag and mask ventilation is done with a pillow; the head and neck are fully extended. | * Mouth to mouth or bag and mask ventilation is done with a pillow; the head and neck are fully extended. | ||
* Apply cricoid pressure until the airway is protected by a cuffed tracheal tube if sufficient staff are available to do this – this decreases risk of gastric aspiration.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | * Apply cricoid pressure until the airway is protected by a cuffed tracheal tube if sufficient staff are available to do this – this decreases the risk of gastric aspiration.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | ||
* A soon as possible tracheal intubation should be inserted – ensures adequate ventilation with increased intra-abdominal pressure.<<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | * A soon as possible tracheal intubation should be inserted – ensures adequate ventilation with increased intra-abdominal pressure.<<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | ||
* Consider using a smaller tracheal tube if the airway is narrowed due to | * Consider using a smaller tracheal tube if the airway is narrowed due to edema and swellling.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | ||
* Positioning for intubation - using one pillow helps to flex the neck and extend the head.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | * Positioning for intubation - using one pillow helps to flex the neck and extend the head.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | ||
==Circulation | ===Circulation Management=== | ||
* Adhesive defibrillator pads attachment are used to assist contact which may be difficult due to the larger breasts in the pregnant woman.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | * Adhesive defibrillator pads attachment are used to assist contact which may be difficult due to the larger breasts in the pregnant woman.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | ||
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* Raising the woman’s legs will assist venous return.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | * Raising the woman’s legs will assist venous return.<ref name="pmid14644974">{{cite journal |author=Morris S, Stacey M |title=Resuscitation in pregnancy |journal=[[BMJ (Clinical Research Ed.)]] |volume=327 |issue=7426 |pages=1277–9 |year=2003 |month=November |pmid=14644974 |pmc=286253 |doi=10.1136/bmj.327.7426.1277 |url=http://www.bmj.com/cgi/pmidlookup?view=long&pmid=14644974 |accessdate=2012-04-16}}</ref> | ||
==Gastrointestinal | ===Gastrointestinal Management=== | ||
Early intubation decreases the risk of gastric aspiration.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | Early intubation decreases the risk of gastric aspiration.<ref name="pmid16321711">{{cite journal |author=Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K |title=European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances |journal=[[Resuscitation]] |volume=67 Suppl 1 |issue= |pages=S135–70 |year=2005 |month=December |pmid=16321711 |doi=10.1016/j.resuscitation.2005.10.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(05)00414-4 |accessdate=2012-04-16}}</ref> | ||
==Intiating | ===Intiating Caesarean Section=== | ||
If a pregnant woman collapses and requires resuscitation then a staff member should immediately collect the Caesarean Section Perimortem pack. | |||
==References== | ==References== | ||
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Latest revision as of 06:57, 15 March 2016
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Cardiac disease in pregnancy Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Cardiac arrest occurs in approximately one in 30,000 women in late pregnancy.[1] Maternal mortality is caused by venous thromboembolism, severe preeclampsia or eclampsia, sepsis, amniotic fluid embolism, haemorrhage, trauma, iatrogenic causes including anaesthesia and drug errors or allergy, and congenital or acquired heart disease.[2]
Urgent hysterotomy or Caesarean section should be considered in the pregnant woman who has a cardiac arrest. If early resuscitation fails, birth of the fetus may improve both the maternal and the fetal chances of survival. Infants over 24-25 weeks gestation have the best chance of survival if birthed within 5 minutes of maternal cardiac arrest. It is recommended that hysterotomy or Caesarean section be initiated within 4 minutes after a cardiac arrest unless there has been a successful resuscitation and maternal perfusion restored within that time.[3]
Resuscitation Strategies
Position of the Pregnant Women
- Position the women on her back with the shoulders flat. Place padding/wedge under the right buttock to give an obvious pelvic tilt to the left.[4]
- The thighs of a rescuer may be used for resting the women on, and providing a lateral tilt.[1]
- An assistant may move the uterus further off the vena cava by lifting the uterus with two hands to the left and towards the woman’s head.[1]
Airway Management
- The woman should be inclined laterally for suction, removing ill-fitting dentures or foreign bodies, and inserting airways.[1]
- Mouth to mouth or bag and mask ventilation is done with a pillow; the head and neck are fully extended.
- Apply cricoid pressure until the airway is protected by a cuffed tracheal tube if sufficient staff are available to do this – this decreases the risk of gastric aspiration.[3]
- A soon as possible tracheal intubation should be inserted – ensures adequate ventilation with increased intra-abdominal pressure.<[3]
- Consider using a smaller tracheal tube if the airway is narrowed due to edema and swellling.[3]
- Positioning for intubation - using one pillow helps to flex the neck and extend the head.[1]
Circulation Management
- Adhesive defibrillator pads attachment are used to assist contact which may be difficult due to the larger breasts in the pregnant woman.[3]
- Hand position higher than the normal position for chest compressions may be needed to adjust for the elevation of the diaphragm and abdominal contents due to the gravid uterus.[3]
- Raising the woman’s legs will assist venous return.[1]
Gastrointestinal Management
Early intubation decreases the risk of gastric aspiration.[3]
Intiating Caesarean Section
If a pregnant woman collapses and requires resuscitation then a staff member should immediately collect the Caesarean Section Perimortem pack.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Morris S, Stacey M (2003). "Resuscitation in pregnancy". BMJ (Clinical Research Ed.). 327 (7426): 1277–9. doi:10.1136/bmj.327.7426.1277. PMC 286253. PMID 14644974. Retrieved 2012-04-16. Unknown parameter
|month=ignored (help) - ↑ Mallampalli A, Powner DJ, Gardner MO (2004). "Cardiopulmonary resuscitation and somatic support of the pregnant patient". Critical Care Clinics. 20 (4): 747–61, x. doi:10.1016/j.ccc.2004.05.005. PMID 15388200. Retrieved 2012-04-16. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K (2005). "European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances". Resuscitation. 67 Suppl 1: S135–70. doi:10.1016/j.resuscitation.2005.10.004. PMID 16321711. Retrieved 2012-04-16. Unknown parameter
|month=ignored (help) - ↑ Australian Resuscitation Council. Guideline 7 Cardiopulmonary resuscitation. In: Australian Resuscitation Council Guidelines; 2006.