Special Patient Groups

Cardiac arrest in pregnancy

• Maternal cardiac arrest is rare.

• The majority of BLS and ACLS algorithms remain the same, including drug and defibrillation dosages.

Modifications to BLS and ACLS

• Displace the uterus manually to the left to relieve aortocaval compression.

  • One-handed manual displacement: Standing on the patient's right, push the uterus up and away.

  • Two-handed manual displacement: Standing on the patient's left, pull the uterus up and towards the rescuer.

• Consider the following causes in addition to the common causes of cardiac arrest (see “Hs and Ts”): [11]

  • Amniotic fluid embolism

  • Uterine atony

  • Placenta abruption or placenta previa (see “Antepartum hemorrhage” for details on management)

  • Eclampsia

• Cardiac arrest due to trauma rarely responds to standard ACLS treatment.

• Management is primarily surgical, i.e., emergency chest decompression and/or emergency thoracotomy followed by operative intervention.