ACLS In-Hospital Cardiac Arrest in Pregnancy Algorithm

Cardiac arrest during pregnancy is rare but extremely serious. It requires quick, coordinated action to save both the mother and the baby. The ACLS In-Hospital Cardiac Arrest in Pregnancy Algorithm provides step-by-step guidance to help healthcare professionals respond effectively in this high-risk situation.
This algorithm focuses on the special needs of pregnant patients, including changes in the body during pregnancy and how they affect CPR. It includes recommendations for high-quality chest compressions, airway support, medication use, and when to consider emergency delivery. Following standard ACLS protocol can greatly improve survival chances for both mother and baby during in-hospital cardiac emergencies.

Step-by-Step Process of the In-Hospital Pregnancy Cardiac Arrest Algorithm

When a pregnant woman experiences cardiac arrest in the hospital, it is a life-threatening emergency for both the mother and baby. The American Heart Association (AHA) provides a special algorithm to guide healthcare professionals through each step of care. This process ensures proper CPR, protects the baby, and increases the chance of survival for both

1. Call for Help and Activate Emergency Response: Immediately alert the code team and obstetric and neonatal specialists.

2. Start High-Quality CPR: Begin chest compressions with slightly higher hand placement on the sternum. Perform at a rate of 100–120 compressions per minute.

3. Manually Displace the Uterus to the Left: This reduces pressure on the large blood vessels and improves blood flow to the heart.

4. Secure the Airway Early: Pregnant women are at high risk of aspiration. Intubate as soon as possible and ensure proper oxygenation and ventilation.

5. Attach Defibrillator and Check Rhythm: Analyze the heart rhythm and give shocks as needed. Follow standard ACLS defibrillation procedures.

6. Administer Medications Carefully: Follow ACLS protocols for epinephrine and other drugs, but be mindful of their effects on the fetus.

7. Identify and Treat Reversible Causes: Identify and treat common reversible causes using the H’s and T’s (hypoxia, toxins, thrombosis, etc.).

8. Consider Perimortem Cesarean Delivery (PMCD): If there is no Return of Spontaneous Circulation (ROSC) after 4 minutes, begin PMCD by 5 minutes to improve outcomes for both mother and baby.

9. Continue Advanced Resuscitation: Continue CPR, medications, and advanced life support until ROSC or termination of efforts is determined.

10. Provide Post-Resuscitation Care: After the heart starts beating again, focus on keeping the mother and baby stable. Support breathing and blood pressure, control temperature, and move them to the ICU for further care.

Key Modifications to Standard ACLS in Pregnancy

ACLS procedures must be adjusted during pregnancy to account for the physiological and anatomical changes in the mother and to protect the unborn baby. These changes affect how CPR is performed, how medications are used, and when certain emergency actions like delivery may be needed. Proper adaptations help improve the survival chances of both mother and baby

1. Manual Left Uterine Displacement (LUD):

A healthcare provider uses one or two hands to lift and displace the uterus to the left to relieve pressure on the major blood vessels and improve blood return to the heart.

2. Higher Hand Placement for Chest Compressions

Compressions should be slightly higher on the sternum than usual due to the upward shift of internal organs during pregnancy.

3. Early Airway Management:

Pregnant patients are at higher risk of airway swelling and aspiration, so secure the airway early and use caution during intubation.

4. Modify Medication Use:

Some medications used in ACLS may have effects on the fetus. Choose drugs with caution and prioritize maternal resuscitation.

5. Consider Perimortem Cesarean Delivery (PMCD):

If no Return of Spontaneous Circulation (ROSC) after 4 minutes, initiate PMCD by 5 minutes to improve outcomes for both mother and baby.

5. Team Coordination is Critical:

Assign clear roles for obstetric, neonatal, and resuscitation teams to ensure timely and efficient care.

Key Takeaways from the In-Hospital Cardiac Arrest in Pregnancy Algorithm

Cardiac arrest during pregnancy is rare but life-threatening for both mother and baby. It is crucial to understand the key modifications to the standard ACLS algorithm, such as uterine displacement, timely airway management, and the potential need for perimortem cesarean delivery, which are essential for improving outcomes. Timely and coordinated action by trained medical teams can make a critical difference.

Suppose you’re a healthcare provider aiming to strengthen your emergency response skills, especially in maternal care. In that case, CPRVAM offers AHA-compliant ACLS training designed for real-world situations, including pregnancy-related cardiac arrests. Our expert-led sessions combine hands-on practice with scenario-based learning to prepare you for high-pressure moments. Take the next step in your medical career by enrolling with CPRVAM today and gain the confidence to save lives when every second matters.

FAQs

1. Why is ACLS different for pregnant patients?

Pregnancy changes the body’s anatomy and physiology, so ACLS steps must be adapted to address these differences, like repositioning the mother to improve blood flow and considering early delivery if needed.

2. What are the American Heart Association guidelines for pregnancy?

The AHA guidelines for pregnancy focus on adapting CPR to protect both mother and baby. This includes placing the mother on her left side to improve blood flow and being ready for emergency delivery if needed. These steps help save lives during pregnancy-related emergencies.

3. Who should know the ACLS Pregnancy Cardiac Arrest Algorithm?

Doctors, nurses, and emergency responders working in maternity, labor, delivery, and critical care units should be trained in this specialized ACLS protocol.

4. How should fetal monitoring be managed during maternal cardiac arrest?

During maternal cardiac arrest, continuous fetal monitoring is important to assess the baby’s condition. If signs show the baby is in distress and the mother’s condition allows, an emergency delivery (perimortem cesarean) may be considered to improve outcomes for both mother and baby.