Quality Education for a Healthier Scotland

Multidisciplinary

Cardiopulmonary Resuscitation: Considerations in third trimester

of pregnancy

Promoting multiprofessional education

and development in Scottish maternity care

Quality Education for a Healthier Scotland

MultidisciplinaryCardiopulmonary Resuscitation

• BLS (Basic Life Support)• ALS (Advanced Life Support)• Role of caesarean section in

cardiopulmonary resuscitation in late pregnancy.

Quality Education for a Healthier Scotland

MultidisciplinaryCardiopulmonary Resuscitation

• 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

MultidisciplinarySHOCKABLEVentricular Fibrillation

Ventricular Tachycardia

Quality Education for a Healthier Scotland

MultidisciplinaryNon-ShockableNON SHOCKABLE

Asystole

NON SHOCKABLEPEA - Complete Heart Block

NON SHOCKABLE PEA narrow complex Tachycardia

Quality Education for a Healthier Scotland

Multidisciplinary

Causes of Cardiac Arrest

4 Hs 4 TsHypoxia ThromboembolismHypovolaemia Toxic (? Magnesium

Sulphate)Hypo/hyperkalaemia TamponadeHypothermia Tension pneumothorax

and also ECLAMPSIA

Quality Education for a Healthier Scotland

MultidisciplinaryCPR with Adaptations

WHY?

Quality Education for a Healthier Scotland

MultidisciplinaryBecause …

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

How is CPR adapted?

Quality Education for a Healthier Scotland

Multidisciplinary

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

Quality Education for a Healthier Scotland

Multidisciplinary

Caesarean section in maternal resuscitation in late pregnancy

• 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

Multidisciplinary

CPR Post Caesarean Section

• 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

Multidisciplinary

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

• 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

MultidisciplinarySummary

• Differences in CPR in pregnant and non-pregnant patients.

• Strategies used to overcome these physiological differences.

• Caesarean section is part of maternal resuscitation in late pregnancy.