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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...
NO DISCLOSURES
JILLIAN’S STORY
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
4:16pm
ACLS BEGINS
4:18pm
INTUBATION ATTEMPT
EPI GIVEN
OB GYN CALLED
4:21pm
ULTRASOUND PERFOMED
OB INTERN RECEIVES MESSAGE
4:24pm
OB INTERN AT THE BEDSIDE
TEAM SEARCHING FOR KIT
3RD INTUBATION ATTEMPT
ANESTHESIA CALLED
4:32pm
INTUBATED
OB GYN TEAM AND ANESTHESIA ARRIVE
4:34pm
PERIMORTEM C-SECTION PERFORMED
NO NEONATAL RESUS KIT AROUND
4:45pm
TPA CONSIDERED FOR PE
CONTINUES IN REFRACTORY PEA
4:50pm
TPA GIVEN
ETCO REMAINS LOW
5:02pm
RHYTHM IS NOW ASYSTOLE
BABY REMAINS UNRESPONSIVE
5:15pm
5:20pm
TIME OF DEATH
CARDIAC ARREST IN PREGNANCY
1:12000 ADM DELIVERIES
14 / YEAR (US)
CARDIAC ARREST IN PREGNANCY
RARE, BUT YOU MUST BE READY
SURVIVAL
58%
WITH PERIMORTEM C SECTION
US 1986 (KATZ) UK 2014 (CAPS STUDY)
RARE, BUT YOU MUST BE READY
1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS
1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS
HEMODYNAMIC
CHANGES
AFTERLOAD
CARDIAC OUTPUT
CARDIAC OUTPUT CARDIAC
ARREST
DOWNTIME
HIGH QUALITY
CPR
ROSC
LOW FLOW (20-30%)
NORMAL FLOW
NO FLOW
RESPIRATORY CHANGES
FRC DECREASES 10-25%
OXYHB CURVE SHIFTS RIGHT
VO2 INCRESES
1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS
CHEST COMPRESSIONS
UNCHANGED HAND POSITIONING
MECHANICAL CPR NOT
RECOMMENDED
POSITION SUPINE
LEFT UTERINE DISPLACEMENT
1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS
LIFE, LIMB & SIGHT SAVING
PROCEDURES EMERGENCY MEDICINE
THORACOTOMY
PERIMORTEM CS
SURGICAL AIRWAY
CANTHOTOMY
PERIMORTEM C-SECTION
GOAL IS TO RESUSCITATE BOTH
PATIENTS
RECOMMENDATION:
BEGIN AT 4 MIN, DELIVER BY 5
INDICATED > 20 WEEKS
WHY 20 WEEKS?
EQUIPMENT
TECHNIQUE
SKIN INCISION
CONTINUE CPR
SMALL OPENING UTERUS
EXTEND UTERINE INCISION
TECHNIQUE
DELIVER BABY
CONTINUE CPR
DELIVER PLACENTA
WAIT OF OB
THE MOST DIFFICULT PART
OF THE PROCEDURE IS THE
DECISION TO DO THE
PROCEDURE
UNDER PRESSURE
WE DON’T RAISE TO THE
OCCASION
WE SINK TO OUR LEVEL OF
TRAINING Archilocus
1. PHYSIOLOGY
2. UNIQUE ASPECTS RESUSCITATION
3. PERIMORTEM C SECTION
4. RESUS TEAM PREPAREDNESS
MATERNAL
CARDIAC ARREST TEAM
ADULT RESUSCITATION
OBSTETRICS (MD + RN)
ANESTHESIA
NEONATOLOGY
I . E .
“ M AT E R N A L C O ...
MULTIDISCIPLINARY
SIMULATION
KNOW THE EQUIPMENT
HAVE A
CHECKLIST
2 LIVES
ITS OUR DUTY TO
BE READY
A RARE EVENT
REWRITE JILLIAN’S STORY
@FTeranMD
THANK YOU
FelipeTeran@gmail.com
Cardiac Arrest Resuscitation in Pregnancy
Cardiac Arrest Resuscitation in Pregnancy
Cardiac Arrest Resuscitation in Pregnancy
Cardiac Arrest Resuscitation in Pregnancy
Cardiac Arrest Resuscitation in Pregnancy
Cardiac Arrest Resuscitation in Pregnancy
Cardiac Arrest Resuscitation in Pregnancy
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Cardiac Arrest Resuscitation in Pregnancy Slide 1 Cardiac Arrest Resuscitation in Pregnancy Slide 2 Cardiac Arrest Resuscitation in Pregnancy Slide 3 Cardiac Arrest Resuscitation in Pregnancy Slide 4 Cardiac Arrest Resuscitation in Pregnancy Slide 5 Cardiac Arrest Resuscitation in Pregnancy Slide 6 Cardiac Arrest Resuscitation in Pregnancy Slide 7 Cardiac Arrest Resuscitation in Pregnancy Slide 8 Cardiac Arrest Resuscitation in Pregnancy Slide 9 Cardiac Arrest Resuscitation in Pregnancy Slide 10 Cardiac Arrest Resuscitation in Pregnancy Slide 11 Cardiac Arrest Resuscitation in Pregnancy Slide 12 Cardiac Arrest Resuscitation in Pregnancy Slide 13 Cardiac Arrest Resuscitation in Pregnancy Slide 14 Cardiac Arrest Resuscitation in Pregnancy Slide 15 Cardiac Arrest Resuscitation in Pregnancy Slide 16 Cardiac Arrest Resuscitation in Pregnancy Slide 17 Cardiac Arrest Resuscitation in Pregnancy Slide 18 Cardiac Arrest Resuscitation in Pregnancy Slide 19 Cardiac Arrest Resuscitation in Pregnancy Slide 20 Cardiac Arrest Resuscitation in Pregnancy Slide 21 Cardiac Arrest Resuscitation in Pregnancy Slide 22 Cardiac Arrest Resuscitation in Pregnancy Slide 23 Cardiac Arrest Resuscitation in Pregnancy Slide 24 Cardiac Arrest Resuscitation in Pregnancy Slide 25 Cardiac Arrest Resuscitation in Pregnancy Slide 26 Cardiac Arrest Resuscitation in Pregnancy Slide 27 Cardiac Arrest Resuscitation in Pregnancy Slide 28 Cardiac Arrest Resuscitation in Pregnancy Slide 29 Cardiac Arrest Resuscitation in Pregnancy Slide 30 Cardiac Arrest Resuscitation in Pregnancy Slide 31 Cardiac Arrest Resuscitation in Pregnancy Slide 32 Cardiac Arrest Resuscitation in Pregnancy Slide 33 Cardiac Arrest Resuscitation in Pregnancy Slide 34 Cardiac Arrest Resuscitation in Pregnancy Slide 35 Cardiac Arrest Resuscitation in Pregnancy Slide 36 Cardiac Arrest Resuscitation in Pregnancy Slide 37 Cardiac Arrest Resuscitation in Pregnancy Slide 38 Cardiac Arrest Resuscitation in Pregnancy Slide 39 Cardiac Arrest Resuscitation in Pregnancy Slide 40 Cardiac Arrest Resuscitation in Pregnancy Slide 41 Cardiac Arrest Resuscitation in Pregnancy Slide 42 Cardiac Arrest Resuscitation in Pregnancy Slide 43 Cardiac Arrest Resuscitation in Pregnancy Slide 44 Cardiac Arrest Resuscitation in Pregnancy Slide 45 Cardiac Arrest Resuscitation in Pregnancy Slide 46 Cardiac Arrest Resuscitation in Pregnancy Slide 47 Cardiac Arrest Resuscitation in Pregnancy Slide 48 Cardiac Arrest Resuscitation in Pregnancy Slide 49 Cardiac Arrest Resuscitation in Pregnancy Slide 50 Cardiac Arrest Resuscitation in Pregnancy Slide 51
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A brief presentation delivered at Conceptos UC Emergency Medicine Conference in Chile, September 2017.

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Cardiac Arrest Resuscitation in Pregnancy

  1. 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. 2. NO DISCLOSURES
  3. 3. JILLIAN’S STORY
  4. 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. 5. 4:16pm ACLS BEGINS
  6. 6. 4:18pm INTUBATION ATTEMPT EPI GIVEN OB GYN CALLED
  7. 7. 4:21pm ULTRASOUND PERFOMED OB INTERN RECEIVES MESSAGE
  8. 8. 4:24pm OB INTERN AT THE BEDSIDE TEAM SEARCHING FOR KIT 3RD INTUBATION ATTEMPT ANESTHESIA CALLED
  9. 9. 4:32pm INTUBATED OB GYN TEAM AND ANESTHESIA ARRIVE
  10. 10. 4:34pm PERIMORTEM C-SECTION PERFORMED NO NEONATAL RESUS KIT AROUND
  11. 11. 4:45pm TPA CONSIDERED FOR PE CONTINUES IN REFRACTORY PEA
  12. 12. 4:50pm TPA GIVEN ETCO REMAINS LOW
  13. 13. 5:02pm RHYTHM IS NOW ASYSTOLE BABY REMAINS UNRESPONSIVE
  14. 14. 5:15pm
  15. 15. 5:20pm TIME OF DEATH
  16. 16. CARDIAC ARREST IN PREGNANCY
  17. 17. 1:12000 ADM DELIVERIES 14 / YEAR (US) CARDIAC ARREST IN PREGNANCY
  18. 18. RARE, BUT YOU MUST BE READY SURVIVAL 58% WITH PERIMORTEM C SECTION
  19. 19. US 1986 (KATZ) UK 2014 (CAPS STUDY) RARE, BUT YOU MUST BE READY
  20. 20. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  21. 21. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  22. 22. HEMODYNAMIC CHANGES AFTERLOAD CARDIAC OUTPUT
  23. 23. CARDIAC OUTPUT CARDIAC ARREST DOWNTIME HIGH QUALITY CPR ROSC LOW FLOW (20-30%) NORMAL FLOW NO FLOW
  24. 24. RESPIRATORY CHANGES FRC DECREASES 10-25% OXYHB CURVE SHIFTS RIGHT VO2 INCRESES
  25. 25. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  26. 26. CHEST COMPRESSIONS UNCHANGED HAND POSITIONING MECHANICAL CPR NOT RECOMMENDED
  27. 27. POSITION SUPINE LEFT UTERINE DISPLACEMENT
  28. 28. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  29. 29. LIFE, LIMB & SIGHT SAVING PROCEDURES EMERGENCY MEDICINE THORACOTOMY PERIMORTEM CS SURGICAL AIRWAY CANTHOTOMY
  30. 30. PERIMORTEM C-SECTION GOAL IS TO RESUSCITATE BOTH PATIENTS RECOMMENDATION: BEGIN AT 4 MIN, DELIVER BY 5 INDICATED > 20 WEEKS
  31. 31. WHY 20 WEEKS?
  32. 32. EQUIPMENT
  33. 33. TECHNIQUE SKIN INCISION CONTINUE CPR SMALL OPENING UTERUS EXTEND UTERINE INCISION
  34. 34. TECHNIQUE DELIVER BABY CONTINUE CPR DELIVER PLACENTA WAIT OF OB
  35. 35. THE MOST DIFFICULT PART OF THE PROCEDURE IS THE DECISION TO DO THE PROCEDURE
  36. 36. UNDER PRESSURE WE DON’T RAISE TO THE OCCASION WE SINK TO OUR LEVEL OF TRAINING Archilocus
  37. 37. 1. PHYSIOLOGY 2. UNIQUE ASPECTS RESUSCITATION 3. PERIMORTEM C SECTION 4. RESUS TEAM PREPAREDNESS
  38. 38. 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 ”
  39. 39. MULTIDISCIPLINARY SIMULATION
  40. 40. KNOW THE EQUIPMENT
  41. 41. HAVE A CHECKLIST
  42. 42. 2 LIVES ITS OUR DUTY TO BE READY A RARE EVENT
  43. 43. REWRITE JILLIAN’S STORY
  44. 44. @FTeranMD THANK YOU FelipeTeran@gmail.com
  • teshman

    Jun. 20, 2020
  • EdwardBuga

    May. 27, 2019
  • AhmedShazly10

    Sep. 5, 2018
  • RadenHade

    Apr. 5, 2018
  • NicholasMakwaga

    Mar. 23, 2018
  • Kathita73

    Oct. 10, 2017

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

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