The association of obstetric anesthesiologists, India – An expert committee consensus statement and recommendations for the management of maternal cardiac arrest

Sunil T Pandya; Kajal Jain; Anju Grewal; Ketan S Parikh; Karuna Sharma; Anjeleena K Gupta; Shilpa Kasodekar; Aruna Parameswari; Daisy Gogoi; Lalit K Raiger; Gonibeed Lakshminarayana Rao Ravindra; Sunanda Gupta; Anjan Trikha

doi:10.4103/JOACC.JOACC_44_22

CONSENSUS STATEMENT

Year : 2022 | Volume : 12 | Issue : 2 | Page : 85-93

The association of obstetric anesthesiologists, India – An expert committee consensus statement and recommendations for the management of maternal cardiac arrest

Sunil T Pandya¹, Kajal Jain², Anju Grewal³, Ketan S Parikh⁴, Karuna Sharma⁵, Anjeleena K Gupta⁶, Shilpa Kasodekar⁷, Aruna Parameswari⁸, Daisy Gogoi⁹, Lalit K Raiger¹⁰, Gonibeed Lakshminarayana Rao Ravindra¹¹, Sunanda Gupta¹², Anjan Trikha¹³
¹ Chief, Deptt of Anesthesia, Perioperative Medicine and Critical Care, AIG Hospitals and Fernandez Hospitals, Hyderabad, Telangana, India
² Professor, Anesthesia and Intensive Care, PGIMER, Chandigarh, India
³ Professor and Head, Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
⁴ Consultant Anesthesiologist, Breach Candy Hospital and Research Centre, Mumbai, Maharashtra, India
⁵ Assoicate Professor, Department of Anesthesia, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
⁶ Senior Consultant, Institute of Anesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
⁷ Chief Anesthesiologist, Department of Anesthesia, PD Hinduja Hospital, Khar, Mumbai, Maharashtra, India
⁸ Professor and Head, Department of Anesthesiology, Critical Care and Pain Medicine, Sri Ramachandra University, Chennai, India
⁹ Chief Anesthesiologist, Department of Anesthesia & Perioperative Care, Pratiksha Hospital, Guwahati, India
¹⁰ Senior Professor, Anesthesiology & Principal, Government Medical College & Hospitals, Sirohi, Rajasthan, India
¹¹ Chief Consultant Anesthesiologist, Janani Anesthesia and Critical Care Services, Shimoga, Karnataka, India
¹² Professor Emeritus, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
¹³ Department of Anesthesia and Perioperative Care, School of Medicine, University of California, San Francisco, USA

Correspondence Address:
Dr. Sunanda Gupta
Professor Emeritus, Geetanjali Medical College and Hospital, Udaipur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/JOACC.JOACC_44_22

Maternal cardiac arrest (MCA) requires a multidisciplinary team well versed in the cascade of steps involved during resuscitation. Historically, maternal outcomes were poor, primarily because cardiac arrest management in pregnant women was neither optimum nor standardized. However, current evidence has shown better maternal survival given the young age and reversible causes of death. There are specific interventions such as manual left uterine displacement (MLUD) for relief of aortocaval compression that, if not performed, may undermine the success of resuscitation. The team should simultaneously explore the etiology of MCA, which could be a combination of pregnancy-related causes and comorbid conditions. Resuscitative Hysterotomy or Resuscitative Uterine Interventions (RUI) should be considered if there is no return of spontaneous circulation following 4–5 min of cardiopulmonary resuscitation. Teamwork is critical to success in the high-stakes environment of MCA. This consensus statement was prepared by the experts after reviewing evidence-based literature on maternal resuscitation during MCA.

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