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Multidisciplinary Cardiopulmonary Resuscitation: Considerations in third trimester of pregnancy Promoting multiprofessional education and development in Scottish maternity care Quality Education for a Healthier Scotland Cardiopulmonary Resuscitation Multidisciplinary • BLS (Basic Life Support) • ALS (Advanced Life Support) • Role of caesarean section in cardiopulmonary resuscitation in late pregnancy. Quality Education for a Healthier Scotland Cardiopulmonary Resuscitation Multidisciplinary • Physiological changes of pregnancy • Adaptations of CPR in pregnancy • Indications for peri-arrest caesarean section. Quality Education for a Healthier Scotland Multidisciplinary Ensure pregnant patient is placed in a lateral tilt Quality Education for a Healthier Scotland Multidisciplinary Ensure pregnant patient is placed in a lateral tilt Quality Education for a Healthier Scotland Multidisciplinary Quality Education for a Healthier Scotland SHOCKABLE Ventricular Fibrillation Ventricular Tachycardia Quality Education for a Healthier Scotland Multidisciplinary Non-Shockable NON SHOCKABLE Asystole NON SHOCKABLE PEA - Complete Heart Block NON SHOCKABLE PEA narrow complex Tachycardia Quality Education for a Healthier Scotland Multidisciplinary Causes of Cardiac Arrest 4 Hs Hypoxia Hypovolaemia Hypo/hyperkalaemia Hypothermia and also ECLAMPSIA Multidisciplinary 4 Ts Thromboembolism Toxic (? Magnesium Sulphate) Tamponade Tension pneumothorax Quality Education for a Healthier Scotland CPR with Adaptations WHY? Quality Education for a Healthier Scotland Multidisciplinary Because … Physiological changes of pregnancy • Aorto-caval compression by gravid uterus impedes venous return and reduces cardiac output. • Increased risk of aspiration of stomach contents. • More likely to be difficult to intubate. • Lower gastric pH- chemical pneumonitis more likely than in the non-pregnant. Quality Education for a Healthier Scotland Multidisciplinary Multidisciplinary How is CPR adapted? Quality Education for a Healthier Scotland CPR Adaptations • Tilt patient to the left or manually displace uterus. • Apply cricoid pressure and intubate early. • Involve senior appropriate member of staff immediately or as early as possible. Quality Education for a Healthier Scotland Multidisciplinary Multidisciplinary Quality Education for a Healthier Scotland Caesarean section in maternal resuscitation in late pregnancy Multidisciplinary • Part of the resuscitation technique. • Decision by four minutes of unsuccessful CPR • Performed by FIVE minutes if CPR is unsuccessful. • Makes CPR more efficient. Quality Education for a Healthier Scotland CPR Post Caesarean Section • • • • Multidisciplinary Increases venous return Improves ease of ventilation CPR can be carried out in the supine position Decreased oxygen requirement after delivery. Quality Education for a Healthier Scotland Caesarean section in maternal resuscitation in late pregnancy • • • • Continue maternal CPR throughout Incision Equipment (scalpel, artery forceps) Potentially good fetal outcome if delivery occurs by 5 minutes of cardiac arrest. Quality Education for a Healthier Scotland Multidisciplinary Other Considerations Multidisciplinary • Effective spinal or epidural will make chest compression LESS effective: larger doses of epinephrine may be required. • If cardiac arrest is due to intravenous bupivacaine, prolonged CPR will be required. Quality Education for a Healthier Scotland Multidisciplinary Any Questions? Quality Education for a Healthier Scotland Summary Multidisciplinary • Differences in CPR in pregnant and nonpregnant patients. • Strategies used to overcome these physiological differences. • Caesarean section is part of maternal resuscitation in late pregnancy. Quality Education for a Healthier Scotland
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