Incidence, Outcomes, and Management of In-Hospital Maternal Cardiac Arrest

Maternal cardiac arrest is a catastrophic event, with data regarding outcomes and feasibility of timely resuscitative hysterotomy remaining scarce. Our retrospective cohort study identified 31 pregnant or postpartum patients with in-hospital cardiac arrest at a tertiary care center over 15.5 years, an incidence of 2 per 10,000 deliveries (95% CI, 1.4-2.8/10,000 deliveries). Return of spontaneous circulation (ROSC) occurred in 87.1% of the patients (95% CI, 75.2-98.8%) within a median of 2 minutes, and 77.4% (95% CI, 62.6-92.1%) survived until discharge. Eleven instances of cardiac arrest (35.5%) occurred antepartum, predominantly due to anesthetic complications. Two resuscitative hysterotomies were performed, with code-to-delivery time of 4 minutes and 100% neonatal survival. Twenty instances of cardiac arrest (64.5%) were immediately postpartum, primarily after hemorrhage or amniotic fluid embolism. Our findings demonstrate high rates of ROSC and survival in a tertiary care setting, which help to confirm feasibility and utility of rapid resuscitative hysterotomy.