CAP Cardiac Arrest – Pregnancy longlivesANESTHESIA PATHWAYS Cardiac arrest in the pregnant patient Start DRUG DOSES and treatments 1. Call for “Anesthesiologist, Obstetrician and Neonatal Team STAT”, a EPInephrine 1 mg IV, repeat every 3 - 5 minutes CODE BLUE, Code Cart, and a Scalpel/Cesarean Pack ANTIARRYTHMICS Amiodarone 1st dose: 300 mg IV, 2nd dose 150 mg IV - ► Say: “The top priority is high-quality, uninterrupted CPR” or- ► Say: “Plan for possible emergency delivery by 4 minutes” Lidocaine 1st dose: 1-1.5mg/kg IV, 2nd dose 0.5- ► Say: “Aim for fetal delivery by 5 minutes” 0.75mg/kg IV Magnesium 1 to 2g IV for Torsades de Pointes 2. Put backboard under patient, supine position, manual left uterine TOXIN treatment displacement Local anesthetic: Intralipid Go to » CHKLST LST 3. Secure the airway (intubate, supraglottic airway), but do not delay Beta-blocker: Glucagon 2-4 mg IV push chest compressions – Anticipate difficult airway Calcium Channel Blocker or Calcium Chloride 1g IV Hyperkalemia 4. Confirm IV access above the diaphragm ► Assess for hypovolemia and give fluid bolus as appropriate ► If Hemorrhage: Go to » CHKLST HEM or PPHEM Potential Contributors to Maternal Cardiac Arrest ► If patient was on IV MgSO4 pre-arrest, give Calcium chloride 1g IV - Anesthetic (high neuraxial block, - Drugs (anaphylaxis, illicit, drug error, loss of airway, aspiration, magnesium, opioid, insulin, oxytocin) -or- Calcium gluconate 3g IV respiratory depression, LAST) - Embolic (PE, AFE, air) 5. Remove fetal monitors - Bleeding (DIC, Uterine Atony, - Fever (Infection, Sepsis) Placenta abruptio/previa) - Hs and Ts (see below) 6. Start CPR - Defibrillation - Assessment cycle: Place AED pads front & back - Cardiovascular (CM, MI, - Hypertension (eclampsia, HELLP, ► Perform CPR dissection, arrhythmia) intracranial bleed - Hard and Fast”; 100 compressions/min - Ensure full chest recoil with minimal interruptions (ETCO2 > Hs & Ts (possible causes) 10, DBP > 20) Hypovolemia Trauma (hemorrhage) - 8 breaths / minute, do not over ventilate Hypoxia Thrombosis (coronary/PE) ► If PEA/Asystole: Go to » CHKLST CAA Hydrogen ion (acidosis) Tension pneumothorax Hyper/ Hypokalemia Tamponade (cardiac) ► Defibrillate (if appropriate) Hypothermia Toxins (local anesthetic, beta - Shock at highest setting Hypoglycemia blockers, calcium channel blockers) - Resume CPR immediately after shock - If VF/VT: Go to » CHKLST CAV During CPR 7. Continue all resuscitation (CPR, ACLS during and after C-Section) Airway: Bag-mask sufficient (if ventilation adequate) Consider advanced airway DEFIBRILLATOR instructions Circulation: Confirm adequate IV or IO access 1. Place electrodes on chest Consider IV fluids wide open 2. Turn defibrillator ON, set to DEFIB mode, and increase ENERGY LEVEL to 200 J Assign Roles: Chest compressions, Airway, Vascular access, Documentation, (120 J or 150 J for smaller stature; 360 J for monophasic) Code cart, Time keeping 3. Deliver shock: press CHARGE then press SHOCK .