Maternal Cardiac Arrest Scenario (ECA)

What is your immediate priority once you confirm the patient is in cardiac arrest?

You prepare to place defibrillator pads. What is the recommended pad placement in maternal cardiac arrest (where there are no issues for placement)?

The charge on an AED/defibrillator should be reduced to avoid harm to the foetus.

You place the pads as per standard adult BLS. The initial rhythm is non-shockable. You consider your next priority. 

Left lateral uterine displacement is not required in maternal arrest unless the patient is more than 30 weeks gestation, so you can move onto your next step.

You ask a family member to help, and they are able to pull the uterus to the left. 

To avoid a family member assisting, it would be appropriate to place pillows on the right-hand side of the patient to create a left lateral tilt, as this has been proven to be just as effective.

Why is left uterine displacement so important in maternal cardiac arrest?

What compression-to-ventilation ratio should be used in maternal resuscitation attempts?

Which airway concern is increased in pregnant patients?

Due to this increased risk, what would be the most appropriate airway adjunct in this scenario (if trained to do so)?

What additional reversible cause, on top of the 4 H’s and T’s, could you consider that may explain a maternal collapse?

A Paramedic crew arrives and begins ALS, gaining IV access and preparing the first adrenaline bolus. They state that they have heard the Critical Care Team are 25 minutes away, and suggest staying on scene until they arrive to take over clinical care. What should you do?

You challenge the decision as you recall JRCALC states a maternal arrest should be conveyed shortly after resuscitation begins. The Paramedic agrees. You load the patient ready to convey. The family member is happy to travel to maintain left uterine displacement. What destination should you head for?

After how long on scene does JRCALC recommend conveying the patient in maternal cardiac arrest?

An early ASHICE to the ED should be given so they can mobilise the correct staff and equipment needed for ongoing resuscitation (e.g., Obstetric Team, Anaesthetics, Neonatal Team, and equipment for peri-mortem caesarean section).

What is the main aim of performing a rapid peri-mortem caesarean section, and why should we not delay on scene?