Among 778,102 deliveries, maternal cardiac arrests occurred at a frequency of 11.2 per 100,000, primarily due to hemorrhage (40.2%) and amniotic fluid embolism (31.0%).
Maternal peripartum cardiac arrest is a rare event (11.2 per 100,000 deliveries) primarily driven by hemorrhage and amniotic fluid embolism, with a 30-day survival rate of 67.8%.
Absolute Event Rate: 0% vs 0%
Background: Prior studies describe maternal cardiac arrest as a rare and often preventable event, but details of clinical care are limited. Our study sought to delineate the frequency, risk factors, etiology, and management of peripartum, peri-anesthetic maternal cardiac arrest in a large, contemporary US cohort. Methods: In this observational cohort study using the Multicenter Perioperative Outcomes Group database, we identified anesthetic records for delivery and up to 7 days postpartum for patients aged 15-44 between 2015 and 2022. A screening algorithm using administrative data, anesthetic medications, electronic record concepts, and free-text notations identified potential cases of maternal cardiac arrest. Two independent reviewers conducted manual chart reviews to adjudicate the presence of cardiac arrest and to assess etiology, timing, management, and outcomes. We used descriptive statistics to assess associations between patient characteristics and cardiac arrest. Results: Among 778,102 deliveries across 60 institutions, we identified 87 cardiac arrests during peripartum, peri-anesthetic care, corresponding to a frequency of 11.2 per 100,000 deliveries 95% CI, 9.1,13.8. The most common etiologies were hemorrhage (40.2%) and amniotic fluid embolism (31.0%); anesthetic complications (e.g., high spinal) accounted for 11.5% of arrests. Most arrests occurred during cesarean deliveries (67.8%). Return of spontaneous circulation was achieved in 77.0% of patients; 67.8% survived to 30 days with a median post-anesthetic hospital length of stay of 6 days. Demographic factors associated with arrest included age ≥40, body mass index ≥40, Black race, and Asian or Pacific Islander race. Clinical factors most strongly associated were pulmonary hypertension, placenta accreta spectrum, ischemic heart disease, and stillbirth. Potential deviations from societal cardiac arrest guidelines were identified in 18.4% of arrests. Conclusions: During peripartum anesthetic management in the US, maternal cardiac arrests most commonly arise from hemorrhage and amniotic fluid embolism. Our findings inform efforts to improve peripartum cardiac arrest guideline adherence and hemorrhage management.
Furdyna et al. (Tue,) reported a other. Among 778,102 deliveries, maternal cardiac arrests occurred at a frequency of 11.2 per 100,000, primarily due to hemorrhage (40.2%) and amniotic fluid embolism (31.0%).