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.