Cardiac Arrest in Pregnancy: End-Tidal CO2 Monitoring Could Guide Management in the Prehospital Setting

*Steinar Einvik,1 Thomas Lafrenz,2 Stein-Vegar Johansen,Ingrid Marie Ringen,4 Per P. Bredmose5

1. Department of Emergency Medicine and Prehospital Services, St. Olavs Hospital,
Trondheim University Hospital, Trondheim, Norway
2. Department of Anaesthesia and Intensive Care, St. Olavs Hospital,
Trondheim University Hospital, Trondheim, Norway
3. Department of Cardiothoracic Anaesthesia, St. Olavs Hospital,
Trondheim University Hospital, Trondheim, Norway
4. Department of Gynecology and Obstetrics, St. Olavs Hospital,
Trondheim University Hospital, Trondheim, Norway
5. Air Ambulance Department, Oslo University Hospital, Oslo, Norway
*Correspondence to steinar.einvik@stolav.no
Steinar Einvik was the prehospital physician on-site. Ingrid Marie Ringen performed perimortem caesarean section in the Emergency Department. Thomas Lafrenz and Stein-Vegar Johansen were the leading physicians inside the hospital Emergency Department. Per P. Bredmose made important contributions to the discussion section. Steinar Einvik was the major contributor to the manuscript.
All authors read and approved the final manuscript.

Disclosure: The authors have declared no conflicts of interest.
Consent: Written informed consent was obtained from the patient’s husband for publication of this
case report.
Received: 18.03.16 Accepted: 09.09.16
Citation: EMJ Cardiol. 2016;4[1]:107-110.

Abstract

This case report describes a 27-year-old pregnant woman with a gestational age of 26 weeks and 3 days who developed cardiac arrest in her home. Resuscitation was started immediately and continued on arrival at the hospital. Guidelines for resuscitation of cardiac arrest during pregnancy in-hospital include that a perimortem caesarean section (PMCS) should be performed if there is no return of spontaneous circulation within 4 minutes. The guidelines for prehospital treatment in such circumstances are more controversial. The triage on-site was based on the end-tidal carbon dioxide (ETCO2) monitoring showing that the quality of resuscitation being done was proficient and after a short on-scene time the patient was transported to the emergency department for PMCS on arrival. The resuscitation of the mother was not successful but the baby survived with no known sequelae after a total arrest time of 28 minutes before delivery. Monitoring of ETCO2 in resuscitation of cardiac arrest in pregnancy might be helpful in making the decision on whether to perform PMCS on-site or at a somewhat more appropriate location in the hospital.

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