Successful resuscitation of a pregnant woman with cardiac arrest by an obstetric rapid response team:a case report and literature review
Objective To investigate the effect of obstetrics rapid response team(RRT)in treating pregnant women with cardiac arrest(CA).Methods A pregnant woman with paroxysmal lower abdominal pain(pregnant woman 1)at 30 gestational weeks admitted to the Shandong Provincial Hospital Affiliated to Shandong First Medical University on July 24,2020 was selected as study subject.The clinical data of pregnant woman 1 such as clinical history,admission-related examination results,and diagnosis and treatment processes was retrospectively analyzed.Medical literature related to pregnant women with CA was reviewed with keywords"pregnant women","pregnancy""heart arrest"and"cardiac arrest"both in Chinese and English as keywords in CNKI,VIP,Wanfang Data service platform and PubMed database.The literature search time was set from the establishment of each database to December 2022.Pregnant woman 1 and the occurrence time,causes and prognosis of CA in pregnant women and related studies were summarized.The procedures followed in this study were in line with the ethical standards set by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University and were approved by the Ethics Committee(Approval No.CXJL:ZQN-202209).Results ①Medical history,admission-related examination results,diagnosis and treatment of pregnant woman 1:26 years old,spontaneous pregnancy,polyhydramnios(amniotic fluid index of 27.4 cm)at admission.On July 27,2020,she was performed with amniotic fluid reduction under ultrasound guidance.At 14:45 on July 29,she had premature rupture of membranes and was admitted to the delivery room for delivery.At 16:18,chest tightness and suffocation suddenly appeared,urgent examination of coagulation function,myocardial enzyme index and N-terminal pro-brain natriuretic peptide(NT-proBNP)level showed:D-dimer level was＞5.93 mg/L,fibrinogen level was 8.46 g/L,hypersensitive troponin T(hs-TnT)level was 242.2 pg/mL,creatine kinase isoenzyme(CKI)level was 16.83 ng/mL,myoglobin level(Mb)was 800.7 ng/mL,NT-proBNP level was 23 643 pg/mL,all of which were significantly higher than normal value.At 16:20,the RRT treatment plan of obstetrics department in our hospital was implemented.At 16:30,preliminary diagnosis of RRT was that pregnant woman 1 was acute myocardial injury and heart failure,the possibility of acute pulmonary embolism and amniotic fluid embolism,RRT recommended preparation for cesarean section delivery under general anesthesia.At 16:52,pregnant woman 1 was transferred to the operating room,CA occurred,obstetric RRT immediately initiated emergency cesarean section delivery plan for sudden death pregnant women,successful cardio-pulmonary resuscitation(CPR)was achieved for 4 minutes,then emergency lower uterine cesarean delivery and bilateral ascending branch ligation of uterine artery were performed immediately under general anesthesia.The operation was successful,and pregnant woman 1 was transferred to intensive care department after operation.A female live neonate was delivered with a birth weight of 1 900 g and a 1-5-10 min Apgar score of 1-3-4.The neonate was transferred to the neonatology department of our hospital for treatment.On July 31,the results of cardiac ultrasound in pregnant women 1 suggest peripartum cardiomyopathy(PPCM),left ventricular ejection fraction(LVEF)of 46％(lower than normal value),and left ventricular diameter(LV)of 52.3 mm(higher than normal value).Pregnant woman 1 was treated by measures to maintain stable vital signs and balance electrolytes,control the volume and rate of intravenous fluid infusion,closely monitor cardiac function-related indicators,temperature,and inflammatory marker changes,and pay attention to organ protection and nutritional support.On August 7th,she was discharged and her newborn was automatically discharged 14 days after birth(August 12),with the loss to follow-up.② Literature review results:according to the literature search strategy set in this study,52 pieces of domestic and foreign literature related to CA pregnant women treatment were retrieved,involving 158 cases of CA pregnant women.Including pregnant woman 1,a total of 159 cases of CA pregnant women were reviewed.Among them,CA occurred in 57 cases(35.8％)before delivery,42 cases(26.5％)during delivery,and 60 cases(37.7％)after delivery.Primary CPR was performed successfully in 120 cases(75.5％)and failed in 39 cases(24.5％).The main causes of CA in pregnant women were hemorrhagic shock(34 cases),amniotic fluid embolism(25 cases),heart disease(19 cases),septic shock(13 cases),severe preeclampsia/eclampsia(12 cases),anesthesia-related complications(8 cases)and others(26 cases).Among the 124 pregnant women with reported prognosis,the maternal mortality rate due to CA was 37.1％(46/124)and among 112 neonates with reported prognosis,the neonatal mortality rate was 49.1％(55/112).Conclusions In this study,the CA pregnant woman is successfully rescued through early warning,one-click call and rapid response of obstetric RRT.The treatment of maternal CA depends on accurate judgment,rapid response,and the cooperation of obstetrics RRT.
Heart arrestHospital rapid response teamCardiopulmonary resuscitationShock,hemorrhagicEmbolism,amniotic fluidCardiomyopathy,peripartumPregnant/post-partum women
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