Coordinate with obstetrics, neonatal, anesthesia, critical care, and cardiology teams.
- Prioritize continuous high-quality CPR and left uterine displacement
- Goal: optimize maternal circulation and improve fetal outcomes
Continue High-Quality BLS/ACLS
- Immediate high-quality CPR; minimize pauses; ensure effective compressions
- Defibrillation when indicated
- Other ACLS interventions (e.g., epinephrine) per rhythm
Assemble a Maternal Cardiac Arrest Team
Consider the Etiology of Cardiac Arrest
| Category | Examples / Notes | Learn more |
|---|---|---|
| Anesthetic complications | Airway events, local anesthetic systemic toxicity | Anesthesia |
| Bleeding | Postpartum hemorrhage, DIC | Obstetric hemorrhage |
| Cardiovascular | MI, cardiomyopathy, aortic dissection | Cardiovascular |
| Drugs | Toxicity, overdose | Toxicology |
| Embolic | Amniotic fluid embolism, PE | Pulmonary Embolism |
| H’s & T’s | Standard reversible causes (hypoxia, hypovolemia, tension pneumothorax, etc.) | ACLS review |
| Hypertension | Severe preeclampsia/eclampsia, intracranial hemorrhage | Preeclampsia |
Maternal Interventions
- Airway management; avoid excessive ventilation; give 100% O2
- Place IV access above the diaphragm
- If receiving IV magnesium, stop and give calcium chloride/gluconate
Obstetric Interventions
- Continuous lateral uterine displacement to relieve aortocaval compression
- Detach fetal monitors (to allow procedures/defibrillation)
- Prepare for perimortem cesarean delivery (PMCD)
Perimortem Cesarean Delivery (PMCD)
If ROSC is not achieved within ~5 minutes, proceed with PMCD when resources/skills permit. The goal is to relieve aortocaval compression and improve maternal perfusion; neonatal team should be ready to receive the newborn.
Advanced Airway in Pregnancy
- Anticipate difficult airway; involve the most experienced provider
- Consider supraglottic airway if intubation fails
- Confirm placement (capnography) and monitor
- Once advanced airway is in place, give 1 breath every 6 seconds (10 breaths/min) while continuing compressions
- Avoid hyperventilation; target visible chest rise and adequate oxygenation
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Bottom line
During maternal cardiac arrest, prioritize high-quality CPR, prompt defibrillation when indicated, left uterine displacement, and parallel maternal/obstetric interventions. If there’s no ROSC within ~5 minutes, proceed to PMCD while the neonatal team prepares for delivery.
This guide is for education only and does not replace clinical judgment or local protocols.