Incidence, outcomes and guideline compliance of out-of-hospital maternal cardiac arrest resuscitations: A population-based cohort study

Alain A Lipowicz; Sheldon Cheskes; Sara H Gray; Farida Jeejeebhoy; Janice Lee; Damon C Scales; Cathy Zhan; Laurie J Morrison; Rescu Investigators

doi:10.1016/j.resuscitation.2018.09.003

Incidence, outcomes and guideline compliance of out-of-hospital maternal cardiac arrest resuscitations: A population-based cohort study

Resuscitation. 2018 Nov:132:127-132. doi: 10.1016/j.resuscitation.2018.09.003. Epub 2018 Sep 7.

Authors

Alain A Lipowicz¹, Sheldon Cheskes², Sara H Gray³, Farida Jeejeebhoy⁴, Janice Lee⁵, Damon C Scales⁶, Cathy Zhan¹, Laurie J Morrison⁷; Rescu Investigators

Collaborators

Rescu Investigators:
Barto Nascimiento, Damon Scales, Dennis Ko, Jamie Hutchison, Katie Dainty, Laurie Morrison, Paul Dorian, Richard Swartz, Richard Verbeek, Sandro Rizoli, Sheldon Cheskes, Steven Brooks, Steve Lin, Tim Chan

Affiliations

¹ Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
² Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
³ Departments of Emergency Medicine and Critical Care, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
⁴ Department of Medicine, University of Toronto, Department of Medicine, William Osler Health System, Toronto, ON, Canada.
⁵ Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Department of Medicine, William Osler Health System, Toronto, ON, Canada.
⁶ Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
⁷ Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Emergency Medicine, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: MorrisonL@smh.ca.

PMID: 30201534
DOI: 10.1016/j.resuscitation.2018.09.003

Abstract

Background: Incidence and survival rates after cardiac arrest among pregnant women are reported for in-hospital cardiac arrests; the incidence and outcomes of maternal out-of-hospital cardiac arrest (OHCA) are unknown. Current cardiopulmonary resuscitation guidelines contain recommendations specific to this population; compliance with these has not been investigated.

Objective: To report maternal OHCA incidence, outcomes, and compliance with recommended treatment guidelines.

Methods: A population-based cohort study of consecutive maternal OHCAs from 2010 to 2014. Census data of all women of childbearing age provided the comparison. Resuscitation performance was measured against the 2010 American Heart Association (AHA) Guidelines.

Results: Six maternal OHCAs were identified among 1085 OHCAs occurring in females of child bearing age (15-49) years; Incidence 1.71 per 100,000 pregnant women (95% CI 0.21 to 6.18) vs. 20.18 OHCAs per 100,000 females of child bearing age (95% CI, 18 to 22.62) p < 0.0001. Survival to hospital discharge was 16.7% (95% CI 3.0, 56.4%) after maternal OHCA vs. 6.8% (95% CI 5.4, 8.4) p < 0.0001 after OHCA in all females of childbearing age, and neonatal survival was 33.3% (95% CI 9.7, 70%). CPR quality metric compliance averaged 83% (range 75% to 100%); compliance with pregnancy-specific resuscitation guidelines ranged from 0% (uterine displacement) to 100% (intravenous line insertion above diaphragm and prehospital maternal team activation).

Conclusion: The incidence of maternal OHCA was 1.71:100,000. Survival was higher after maternal OHCA than after OHCA of non-pregnant females of childbearing age. Pregnancy-specific guideline compliance was low suggesting a need for training and better documentation to improve outcomes in these rare events.

Keywords: CPR and emergency cardiac care; Compliance/adherence; Epidemiology.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiopulmonary Resuscitation / methods*
Cardiopulmonary Resuscitation / statistics & numerical data
Case-Control Studies
Cohort Studies
Emergency Medical Services / methods
Emergency Medical Services / statistics & numerical data
Female
Guideline Adherence*
Humans
Incidence
Middle Aged
Out-of-Hospital Cardiac Arrest / mortality*
Out-of-Hospital Cardiac Arrest / therapy
Pregnancy
Pregnancy Complications, Cardiovascular / mortality*
Pregnancy Complications, Cardiovascular / therapy
Treatment Outcome

Grants and funding

CIHR/Canada