Maternal out-of-hospital cardiac arrest: A retrospective observational study

Resuscitation. 2019 Feb;135:205-211. doi: 10.1016/j.resuscitation.2018.11.001. Epub 2018 Dec 16.

Abstract

Aim: Out-of-hospital cardiac arrests (OHCAs) in pregnant women are rare events. In this study, we aimed to describe a cohort of pregnant women who experienced OHCAs in a large urban area, and received treatment by the prehospital teams in a two-tiered emergency response system.

Methods: This retrospective study included pregnant women over 18 years of age who experienced OHCAs. The analysed variables included maternal age, gestational age, variables specific to the rescue system, number of shocks delivered by an automatic external defibrillator, and rates of maternal and neonatal survival.

Results: Over the 5-year study period, 19,515 OHCAs occurred, 16 of which were in pregnant women. These 16 patients had a median age of 31 years [interquartile range (IQR): 28-35] and a median gestational age of 20 weeks [IQR: 10-33]. Three patients (18.8%) had an initial rhythm of ventricular fibrillation. Only one patient underwent thrombolysis. Of the 16 patients, 6 (38%) died after resuscitation on the scene. The remaining 10 were transported to the hospital, of whom 5 achieved circulation through a mechanical CPR device. Only 2 patients were alive 30days after OHCA.

Conclusions: Over half of the pregnant women who experienced OHCA were at least 20 weeks pregnant. Analysis of the prehospital medical data suggests that the current recommendations are difficult to apply in an out-of-hospital environment. Specific recommendations for this situation must be developed.

Keywords: Extracorporeal membrane oxygenation; Maternofoetal outcomes; Out-of-hospital cardiac arrest; Perimortem caesarean section; Pregnancy; Thrombolysis.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Cardiopulmonary Resuscitation* / methods
  • Cardiopulmonary Resuscitation* / statistics & numerical data
  • Emergency Medical Services* / methods
  • Emergency Medical Services* / statistics & numerical data
  • Female
  • France / epidemiology
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Male
  • Maternal Age
  • Out-of-Hospital Cardiac Arrest* / etiology
  • Out-of-Hospital Cardiac Arrest* / mortality
  • Out-of-Hospital Cardiac Arrest* / therapy
  • Outcome and Process Assessment, Health Care
  • Pregnancy
  • Pregnancy Complications* / diagnosis
  • Pregnancy Complications* / mortality
  • Pregnancy Complications* / therapy
  • Retrospective Studies
  • Survival Analysis
  • Ventricular Fibrillation* / complications
  • Ventricular Fibrillation* / diagnosis
  • Ventricular Fibrillation* / mortality
  • Ventricular Fibrillation* / therapy