Key result
ECPR shows 100% maternal survival after cardiac arrest in pregnancy vs other resuscitative strategies.
Why the study?
Cardiac arrest during pregnancy is rare and life-threatening, and the roles of resuscitative delivery and extracorporeal cardiopulmonary resuscitation remain unclear.
Does the initial resuscitation strategy (RD and/or ECPR) improve maternal and neonatal outcomes in pregnant patients with cardiac arrest?
Systematic Review (n=268)
Does the initial resuscitation strategy (RD and/or ECPR) improve maternal and neonatal outcomes in pregnant patients with cardiac arrest?
Maternal and neonatal outcomes after cardiac arrest during pregnancy vary widely depending on the use of resuscitative delivery and ECPR, though current evidence is limited to case reports.
No takes yet. Share an insight, caveat, or question.
Supports individualized resuscitation in pregnant cardiac arrest; leaves open optimal roles for RD and ECPR pending higher-quality data.
Background Cardiac arrest during pregnancy is a rare, life-threatening event. The roles of resuscitative delivery (RD) and extracorporeal cardiopulmonary resuscitation (ECPR) remain unclear. This systematic review summarizes maternal and neonatal outcomes according to initial resuscitation strategy. Methods This systematic review followed a preplanned protocol registered in the Open Science Framework and adhered to PRISMA guidelines. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi were searched from inception to May 8, 2025, without language restrictions. Cases were categorized by initial resuscitation strategy into four groups: RD–/ECPR–, RD+/ECPR–, RD–/ECPR+, and RD+/ECPR+. Results A total of 150 studies were included, comprising predominantly case reports and describing 268 pregnant patients with cardiac arrest and 274 neonates from 34 countries (2000–2025). Initial resuscitation strategies were RD–/ECPR– in 71/268 (26.5%), RD+/ECPR– in 184/268 (68.7%), RD–/ECPR + in 5/268 (1.9%), and RD+/ECPR + in 8/268 (3.0%). Favorable neurological outcomes were reported in 37/61 (61.9%), 39/146 (26.7%), 4/5 (80.0%), and 2/8 (25.0%), respectively, among cases with available data. Maternal survival beyond ICU admission (mid-term survival) was observed in 46/66 (69.7%), 69/171 (40.3%), 5/5 (100%), and 6/8 (75.0%), respectively. Neonatal survival beyond ICU admission was observed in 29/58 (50.0%), 61/101 (60.4%), 3/5 (60.0%), and 4/7 (57.1%). Among cases receiving both RD and ECPR, ECPR was initiated after RD in six cases and preceded RD in one case. Conclusions Maternal and neonatal outcomes after cardiac arrest during pregnancy varied widely across resuscitation strategies. The available evidence is limited by small, case-based reports, highlighting the need for large registries and multicenter studies to define the optimal use and sequencing of RD and ECPR. Trial registration A preplanned protocol for systematic review has been registered in the Open Science Framework (Osf.io) [https://osf.io/9xsrt/files/osfstorage].
Hongo et al. (2026) conducted a systematic review in Cardiac arrest during pregnancy (n=268). Advanced resuscitation strategies (Resuscitative delivery and/or ECPR) vs. Conventional CPR (RD-/ECPR-) was evaluated on Maternal survival beyond ICU admission (mid-term survival). Maternal mid-term survival after cardiac arrest in pregnancy varied by strategy: 69.7% with conventional CPR, 40.3% with resuscitative delivery, 100% with ECPR, and 75.0% with combined therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: