Perimortem Cesarean Delivery for Maternal Cardiac Arrest

Mapping Intimacies ◽

10.1093/med/9780190226459.003.0042 ◽

2017 ◽

Author(s):

Benjamin Cobb ◽

Steven Lipman

Keyword(s):

Cardiac Arrest ◽

Cesarean Section ◽

Cesarean Delivery ◽

Fetal Outcome ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Effective Application ◽

Integral Component ◽

Great Vessels ◽

Perimortem Cesarean Section

In the absence of a return of spontaneous circulation during maternal cardiac arrest, a perimortem cesarean section should be strongly considered as an integral component of maternal resuscitation. Uterine compression of the great vessels in the second–third trimesters may contribute to ineffective resuscitative measures. In addition, in the setting of ongoing maternal compromise, fetal outcome may be optimized by delivery. The rarity of maternal cardiac arrest poses a multitude of challenges in the effective application of a perimortem cesarean delivery. Nevertheless, perimortem cesarean delivery remains an essential rescue maneuver for women with periviable fetuses who do not respond to initial resuscitative maneuvers.

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Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

Case Reports in Emergency Medicine ◽

10.1155/2014/121562 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Francesca Gatti ◽

Marco Spagnoli ◽

Simone Maria Zerbi ◽

Dario Colombo ◽

Mario Landriscina ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cesarean Section ◽

Surgical Intervention ◽

Hemodynamic Instability ◽

Spontaneous Circulation ◽

Traditional Treatment ◽

Return Of Spontaneous Circulation ◽

Traumatic Cardiac Arrest ◽

Perimortem Cesarean Section

The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

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Loperamide Induced Recurrent Torsades de Pointes: A Case Report

Journal of Pharmacy Practice ◽

10.1177/08971900211004832 ◽

2021 ◽

pp. 089719002110048

Author(s):

Gregory G. Jackson ◽

Christine R. Lopez ◽

Elizabeth S. Bermudez ◽

Nina E. Hill ◽

Dan M. Roden ◽

...

Keyword(s):

Cardiac Arrest ◽

Torsades De Pointes ◽

Altered Mental Status ◽

Spontaneous Circulation ◽

Prior History ◽

Common Phenomenon ◽

Medical Providers ◽

Return Of Spontaneous Circulation ◽

History Of ◽

Overdrive Pacing

Purpose: A case of loperamide-induced recurrent torsades de pointes is reported to raise awareness of an increasingly common phenomenon that could be encountered by medical providers during the current opioid epidemic. Summary: A 40 year-old-man with a prior history of opioid abuse who presented to the emergency department after taking up to 100 tablets of loperamide 2 mg daily for 5 years to blunt opioid withdrawal symptoms and was subsequently admitted to the intensive care unit for altered mental status and hyperthermia. The patient had prolonged QTc and 2 episodes of torsades de pointes (TdP) that resulted in cardiac arrest with return of spontaneous circulation. He was managed with isoproterenol, overdrive pacing, and methylnatrexone with no other events of TdP or cardiac arrest. Conclusion: A 40-year-old male who developed torsades de pointes from loperamide overdose effectively treated with overdrive pacing, isoproterenol, and methylnatrexone.

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Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

Scientific Reports ◽

10.1038/s41598-021-83270-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tiffany S. Ko ◽

Constantine D. Mavroudis ◽

Ryan W. Morgan ◽

Wesley B. Baker ◽

Alexandra M. Marquez ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hemoglobin Concentration ◽

Spontaneous Circulation ◽

Youden Index ◽

Swine Model ◽

Return Of Spontaneous Circulation ◽

Non Invasive ◽

Tissue Optical Properties ◽

Tenfold Cross Validation

AbstractNeurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO2], [Hb]), oxygen saturation (StO2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (Jw, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO2], StO2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

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