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Pregnancy and cardiac arrest

Question Type:
Intervention
Full Question:
Among pregnant women who are in cardiac arrest in any setting (P), does any specific intervention(s) (I), compared with standard care (usual resuscitation practice) (C), change ROSC, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year (O)?
Consensus on Science:
There were no comparative studies of uterine displacement for women in cardiac arrest before delivery. No studies compared different maneuvers (eg, manual displacement versus left pelvic tilt) to achieve optimal uterine displacement for women in cardiac arrest before delivery. Physiologic reviews and studies of uterine displacement maneuvers in nonarrest pregnant women support that uterine displacement might be physiologically beneficial for women in cardiac arrest.(Cyna 2006, CD002251) Any benefit would have to be weighed against the potential interference or delay with usual resuscitation care.For the critical outcomes of survival with favorable neurologic/functional outcome at discharge, 30 days, 60 days, 180 days, and/or 1 year, and survival only at discharge, 30 days, 60 days, 180 days, and/or 1 year, and the important outcomes of ROSC, we found 3 observational studies of 154 subjects collectively(Dijkman 2010, 282; Einav 2012, 1191; Baghirzada 2013, 1077) that provided very-low-quality evidence (downgraded for very serious risk of bias and imprecision, and serious inconsistency) comparing cardiac arrest resuscitation with or without perimortem cesarean delivery. The procedures to ascertain cases and controls in these studies were significantly different so that the pooled comparison of any of the assigned outcomes is considered inappropriate.
Treatment Recommendation:
We suggest delivery of the fetus by perimortem cesarean delivery for women in cardiac arrest in the second half of pregnancy (weak recommendation, very-low-quality evidence). There is insufficient evidence to define a specific time interval by which delivery should begin. High-quality usual resuscitation care and therapeutic interventions that target the most likely cause(s) of cardiac arrest remain important in this population.There is insufficient evidence to make a recommendation regarding the use of left lateral tilt and/or uterine displacement during CPR in the pregnant patient. Values, Preferences, and Task Force InsightsIn making this statement, we place value on maternal and neonatal survival, on the absence of data on left lateral tilt and uterine displacement in women with cardiac arrest, and on our uncertainty about the absolute effect of either uterine displacement or perimortem delivery during CPR on any of the assigned outcomes. The task force thought not making a recommendation for or against the use of left lateral tilt or uterine tilt is unlikely to change current practice or guidelines.
CoSTR Attachments:
ALS 436 Pregnancy text and endnote 1-15-15_n.docx    
Mhyre Zelop Pregnancy Excel Tables 2-9-14.xlsx    

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