A brief presentation delivered at Conceptos UC Emergency Medicine Conference in Chile, September 2017.

1. CARDIAC ARREST IN
PREGNANCYF E L I P E T E R A N M D
D I V I S I O N O F E M E R G E N C Y U L T R A S O U N D
& C E N T E R F O R R E S U S C I T A T I O N S C I E N C E
D E P A R T M E N T O F E M E R G E N C Y M E D I C I N E
U N I V E R S I T Y O F P E N N S Y L V A N I A
@FTeranMD

2. NO DISCLOSURES

3. JILLIAN’S STORY

4. N O PA L PA B L E P U L S E
U N R E S P O N S I V E
A P N E I C

5. 4:16pm
ACLS BEGINS

6. 4:18pm
INTUBATION ATTEMPT
EPI GIVEN
OB GYN CALLED

7. 4:21pm
ULTRASOUND PERFOMED
OB INTERN RECEIVES MESSAGE

8. 4:24pm
OB INTERN AT THE BEDSIDE
TEAM SEARCHING FOR KIT
3RD INTUBATION ATTEMPT
ANESTHESIA CALLED

9. 4:32pm
INTUBATED
OB GYN TEAM AND ANESTHESIA ARRIVE

10. 4:34pm
PERIMORTEM C-SECTION PERFORMED
NO NEONATAL RESUS KIT AROUND

11. 4:45pm
TPA CONSIDERED FOR PE
CONTINUES IN REFRACTORY PEA

12. 4:50pm
TPA GIVEN
ETCO REMAINS LOW

13. 5:02pm
RHYTHM IS NOW ASYSTOLE
BABY REMAINS UNRESPONSIVE

14. 5:15pm

15. 5:20pm
TIME OF DEATH

17. CARDIAC ARREST IN PREGNANCY

18. 1:12000 ADM DELIVERIES
14 / YEAR (US)
CARDIAC ARREST IN PREGNANCY

19. RARE, BUT YOU MUST BE READY
SURVIVAL
58%
WITH PERIMORTEM C SECTION

20. US 1986 (KATZ) UK 2014 (CAPS STUDY)
RARE, BUT YOU MUST BE READY

21. 1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS

22. 1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS

23. HEMODYNAMIC
CHANGES
AFTERLOAD
CARDIAC OUTPUT

26. CARDIAC OUTPUT CARDIAC
ARREST
DOWNTIME
HIGH QUALITY
CPR
ROSC
LOW FLOW (20-30%)
NORMAL FLOW
NO FLOW

27. RESPIRATORY CHANGES
FRC DECREASES 10-25%
OXYHB CURVE SHIFTS RIGHT
VO2 INCRESES

28. 1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS

29. CHEST COMPRESSIONS
UNCHANGED HAND POSITIONING
MECHANICAL CPR NOT
RECOMMENDED

30. POSITION SUPINE
LEFT UTERINE DISPLACEMENT

32. 1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS

33. LIFE, LIMB & SIGHT SAVING
PROCEDURES EMERGENCY MEDICINE
THORACOTOMY
PERIMORTEM CS
SURGICAL AIRWAY
CANTHOTOMY

34. PERIMORTEM C-SECTION
GOAL IS TO RESUSCITATE BOTH
PATIENTS
RECOMMENDATION:
BEGIN AT 4 MIN, DELIVER BY 5
INDICATED > 20 WEEKS

35. WHY 20 WEEKS?

36. EQUIPMENT

39. TECHNIQUE
SKIN INCISION
CONTINUE CPR
SMALL OPENING UTERUS
EXTEND UTERINE INCISION

40. TECHNIQUE
DELIVER BABY
CONTINUE CPR
DELIVER PLACENTA
WAIT OF OB

41. THE MOST DIFFICULT PART
OF THE PROCEDURE IS THE
DECISION TO DO THE
PROCEDURE

42. UNDER PRESSURE
WE DON’T RAISE TO THE
OCCASION
WE SINK TO OUR LEVEL OF
TRAINING Archilocus

43. 1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS

44. MATERNAL
CARDIAC ARREST TEAM
ADULT RESUSCITATION
OBSTETRICS (MD + RN)
ANESTHESIA
NEONATOLOGY
I . E .
“ M AT E R N A L C O D E B LU E ”

45. MULTIDISCIPLINARY
SIMULATION

46. KNOW THE EQUIPMENT

47. HAVE A
CHECKLIST

48. 2 LIVES
ITS OUR DUTY TO
BE READY
A RARE EVENT

49. REWRITE JILLIAN’S STORY

51. @FTeranMD
THANK YOU
FelipeTeran@gmail.com