cardiopulmonary resuscitation and pregnancy

CPR On A Pregnant Woman If a pregnant woman suffers cardiac arrest, you want to perform the same three life-saving actions that you would for anyone else. Specifically, you need to call 108, perform CPR, and use an AED to restart the heart.
Do we put our hands in the same place for chest compressions? Yes; this part of CPR is no different. Hands are placed over the lower half of the sternum, just as with CPR for any other adult. Compressions are given to a depth of at least two inches, at the rate of 100-120 per minute.
The enlarging uterus can produce increased afterload through compression of the aorta and decreased cardiac return through compression of the inferior vena cava, starting at ≈12 to 14 weeks of gestational age. As a result, the supine position, which is most favorable for resuscitation, can lead to hypotension.

1. Cardiac Arrest in Pregnancy IH ACLS

2. Cardiac Arrest in Pregnancy

3. Post-Cardiac Arrest/ Ressusctation Care

4. Post Resuscitation Care What is it? Where does it start? Why is it done poorly? What is Post Cardiac Arrest Syndrome? What is Therapeutic Hypothermia?

5. Post Cardiac Arrest Syndrome!! Thought to be RT production of free radicals Pathophysiology is very complex = BORING Hypoperfusion & Ischaemia cause cascade of events Disruption of homeostasis 2. Free radical formation 3. Protease activation Hypothermia helps slow down this cascade

6. The Big 4 in Postcardiac Arrest Syndrome Postcardiac arrest brain injury Disruption of cerebral perfusion may result in Ischaemia/ hyperaemia 2. Postcardiac arrest myocardial dysfunction Initially heart becomes hyperkinetic from catecholamine's, then global hypokinesis follows 3. Systemic Ischaemia/reperfusion Response Similar to septic shock, activation of immune and compliment systems, release inflammatory cytokines, wide range of cellular responses 4. Persistent precipitating pathology Cause of arrest may continue to impact physiological parameters

7. Therapeutic Hypothermia ‘Induced hypothermia” is were pt is deliberately cooled between 32-33.9°C It aims to reduce hypoperfusion (& reperfusion) injury post arrest. Focuses mainly on brain (neuroprotection), but offers protection to heart, liver, kidneys. Current research shows benefit of inducing TH before or during event.

8. Therapeutic Hypothermia Therapeutic hypothermia is the first treatment that has proven effective for post-resuscitation reperfusion injury.

9. Indications Cardiac arrest with ROSC Persistent significant altered level of consciousness <12 hours from time of ROSC Patients >18 years.

10. Indication Relative: Persistent hypotension (MAP <60, SBP<90) despite use of inotropes and vasoconstrictors Note: Hypothermia will cause vasoconstriction And help to increase B.P

11. Contraindication Advanced directive stipulating DNR (absolute) Traumatic arrest. Active bleeding (including intracranial). Pregnancy, recent major surgery, severe sepsis.

12. What are the 3 Phase’s of TH? Induction Aim reduce core temp 32-34°C (within 6 hours, preferably 2 hours) Maintenance Maintain core body temp for 12-24 hours. Rewarming Either controlled or passive rewarming to normothermia 37°C 0.2-0.5°C per hour –over 8-12 hours.

13. ED Management

14. Cooling Methods Cold saline (during arrest & post arrest) ICE Packs (axilla, groin) Keep patients dry. Monitor skin integrity Machine (Vest, Artic Ice)

15. Article required Patient airway secured (sedated & paralyzed) ICE and bags Cold saline 12 lead ECG Arterial line NGT Rectal probe CVC

16. ED Management Airway secure ETT, continuous EtCO2 Breathing Prevent VILI Circulation ECG (risk arrhythmias) Monitor U/O (cold diuresis) Disability Paralyze, sedate Exposure Core temp monitoring Monitoring skin integrity Once at 34°C remove ICE packs & maintain Monitor and prevent shivering Prepare patient for T/F to ICU, Cath Lab

17. Monitoring the bloods

18. Remember the basics Pressure area care. VTE prophylaxis Stress ulcer prophylaxis Lung protective ventilation Nutrition Social support (family)

19. Complications Tachycardia > bradycardia Hypertension Diuresis (hypovolaemia) Shivering (increases temp) Arrhythmia's Increase bleeding Spiking temp’s look for signs of infection

20. Thank-You