Friday, April 4, 2014

Cardiopulmonary Arrest in Pregnancy

Cardiac arrest occurs only about one in every 30,000 late pregnancies, but survival from such an event is exceptional.
Because of the increased risk of regurgitation and pulmonary aspiration of gastric contents in late pregnancy, cricoid pressure should be applied until the airway has been protected by a cuffed tracheal tube.
Ventilation is made more difficult by the increased oxygen requirements and reduced chest compliance in pregnancy. The reduced compliance is due to rib flaring and splinting of the diaphragm by the abdominal contents. Observing the rise and fall of the chest in pregnant patients is also more difficult.
A pregnant patient requiring chest compressions should have a Cardiff Wedge or other device achieving approximately a 30° tilt placed under her back. This allows the patient to have adequate support of the torso for cardiopulmonary resuscitation (CPR) but also minimizes compression of the inferior vena cava (IVC). A backboard with rolled up towels or pillows under one side can substitute.
The pregnant patient can safely undergo direct current cardioversion, both synchronized and unsynchronized. Drugs such as lidocaine, procainamide, adenosine, and quinidine can be safely used in the gravidpatient. Amiodarone is contraindicated secondary to the possible effects on fetal thyroid development.
It is possible for an emergent cesarean section to be performed during CPR.

                                  Cardiff Wedge

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