Cardiopulmonary Resuscitation: Considerations in third trimester of pregnancy Promoting multiprofessional education and development in Scottish maternity care

Cardiopulmonary Resuscitation BLS (Basic Life Support) ALS (Advanced Life Support) Role of caesarean section in cardiopulmonary resuscitation in late pregnancy.

Cardiopulmonary Resuscitation Physiological changes of pregnancy Adaptations of CPR in pregnancy Indications for peri-arrest caesarean section.

Ensure pregnant patient is placed in a lateral tilt

Ensure pregnant patient is placed in a lateral tilt

SHOCKABLE Ventricular Fibrillation Ventricular Tachycardia

PEA - Complete Heart Block PEA narrow complex Tachycardia Non-Shockable NON SHOCKABLE Asystole NON SHOCKABLE PEA - Complete Heart Block NON SHOCKABLE PEA narrow complex Tachycardia

Causes of Cardiac Arrest 4 Hs 4 Ts Hypoxia Thromboembolism Hypovolaemia Toxic (? Magnesium Sulphate) Hypo/hyperkalaemia Tamponade Hypothermia Tension pneumothorax and also ECLAMPSIA LA is local anaesthetic

CPR with Adaptations WHY?

Because … 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.

How is CPR adapted?

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.

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.

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.

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.

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.

Any Questions?

Summary 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.