Background
Maternal in-hospital cardiac arrest is a rare event with the potential for resuscitation
treatment delays because of the difficulty accessing hospital obstetrical units and
limited simulation training or resuscitation experience of obstetrical staff. However,
it is unclear whether survival rates and processes of care differ between women with
a maternal in-hospital cardiac arrest and those with a nonmaternal in-hospital cardiac
arrest.
Objective
We aimed determine whether to there are delays in process measures and differences
in survival outcomes between pregnant and nonpregnant women who have in-hospital cardiac
arrest.
Study Design
Using data from 2000 to 2019 in the Get With The Guidelines-Resuscitation registry,
we compared resuscitation outcomes between women aged 18 to 50 years with a maternal
or nonmaternal in-hospital cardiac arrest. Using a nonparsimonious propensity score,
we matched patients with a maternal in-hospital cardiac arrest to as many as 10 women
with a nonmaternal in-hospital cardiac arrest. We constructed conditional logistic
regression models to compare survival outcomes (survival to discharge, favorable neurologic
survival [discharge cerebral performance score of 1], and return of spontaneous circulation)
and processes of care (delayed defibrillation [>2 minutes] and administration of epinephrine
[>5 minutes]) between women with a maternal in-hospital cardiac arrest vs those with
a nonmaternal in-hospital cardiac arrest.
Results
Overall, 421 women with a maternal in-hospital cardiac arrest were matched by propensity
score to 2316 women with a nonmaternal in-hospital cardiac arrest. The mean age among
propensity score–matched women with a maternal in-hospital cardiac arrest was 31.4
(standard deviation, 6.5) years, where 33.7% were of Black race and 86.9% had an initial
nonshockable cardiac arrest rhythm. Unadjusted survival rates were higher in women
with a maternal in-hospital cardiac arrest than in women with a nonmaternal in-hospital
cardiac arrest: survival to discharge of 45.1% vs 26.5%, survival with cerebral performance
category 1 status of 36.1% vs 17.7%, and return of spontaneous circulation of 75.8%
vs 70.6%. After adjustment, there was no difference in the likelihood of survival
to discharge (odds ratio, 1.19; 95% confidence interval, 0.82–1.73) or return of spontaneous
circulation (odds ratio, 0.94; 95% confidence interval, 0.65–1.35) between women with
a maternal in-hospital cardiac arrest and those with a nonmaternal in-hospital cardiac
arrest. However, women with a maternal in-hospital cardiac arrest were more likely
to have favorable neurologic survival (odds ratio, 1.57; 95% confidence interval,
1.06–2.33). Compared with women with a nonmaternal in-hospital cardiac arrest, women
with a maternal in-hospital cardiac arrest had similar rates of delayed defibrillation
(42.5% vs 34.4%; odds ratio, 1.14 [95% confidence interval, 0.41–3.18]; P=.31) and delayed administration of epinephrine (13.8% vs 10.6%; odds ratio, 0.96
[95% confidence interval, 0.50–1.86]; P=.09).
Conclusion
Although concerns have been raised about resuscitation outcomes in women with a maternal
in-hospital cardiac arrest, the rates of survival and resuscitation processes of care
were not worse in women with a maternal in-hospital cardiac arrest.
Key words
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References
- Cardiac arrest in pregnancy: a scientific statement from the American Heart Association.Circulation. 2015; 132: 1747-1773
- The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy.Anesth Analg. 2014; 118: 1003-1016
- Cardiac arrest and resuscitation unique to pregnancy.Obstet Gynecol Clin North Am. 2016; 43: 809-819
- Cardiac arrest during pregnancy: ongoing clinical conundrum.Am J Obstet Gynecol. 2018; 219: 52-61
- Assessment of knowledge regarding cardiopulmonary resuscitation of pregnant women.Int J Obstet Anesth. 2008; 17: 20-25
- A survey of labour ward clinicians’ knowledge of maternal cardiac arrest and resuscitation.Int J Obstet Anesth. 2008; 17: 238-242
- Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises.Am J Obstet Gynecol. 2010; 203: 179.e1-179.e5
- Association between prompt defibrillation and epinephrine treatment with long-term survival after in-hospital cardiac arrest.Circulation. 2018; 137: 2041-2051
- Delays in cardiopulmonary resuscitation, defibrillation, and epinephrine administration all decrease survival in in-hospital cardiac arrest.Anesthesiology. 2019; 130: 414-422
- Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of cardiopulmonary resuscitation.Resuscitation. 2003; 58: 297-308
- Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style’. American Heart Association.Circulation. 1997; 95: 2213-2239
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).Circulation. 2004; 110: 3385-3397
- Assessment of outcome after severe brain damage.Lancet. 1975; 1: 480-484
- Long-term outcomes in elderly survivors of in-hospital cardiac arrest.N Engl J Med. 2013; 368: 1019-1026
- Part 7: adult advanced cardiovascular life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2015; 132: S444-S464
- American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Delayed time to defibrillation after in-hospital cardiac arrest.N Engl J Med. 2008; 358: 9-17
- Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.Pharm Stat. 2011; 10: 150-161
- Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.Stat Med. 2009; 28: 3083-3107
- Characteristics and outcomes of maternal cardiac arrest: a descriptive analysis of Get with the guidelines data.Resuscitation. 2018; 132: 17-20
Article Info
Publication History
Published online: October 21, 2021
Accepted:
September 28,
2021
Received in revised form:
September 25,
2021
Received:
May 21,
2021
Footnotes
M.T. and V.H. are supported by a T32 grant from the National Institutes of Health (grant number T32HL110837). P.S.C. is supported by grants from National Heart Lung and Blood Institute (grant number 1R01HL123980). Y.T. and A.G. report no conflict of interest. The American Heart Association’s Get With The Guidelines-Resuscitation investigators are sponsored by the American Heart Association .
None of the funding partners had a role in the study design, data analysis, or manuscript preparation and revision.
Cite this article as: Thomas M, Hejjaji V, Tang Y, et al. Survival outcomes and resuscitation process measures in maternal in-hospital cardiac arrest. Am J Obstet Gynecol 2022;226:401.e1-10.
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