naa a22 4500 510744702 CHVBK 20180411083041.0 cr unu---uuuuu 180411e20131101xx s 000 0 eng 10.1007/s12630-013-0021-9 doi (NATIONALLICENCE)springer-10.1007/s12630-013-0021-9 Maternal cardiac arrest in a tertiary care centre during 1989-2011: a case series [Elektronische Daten] [Leyla Baghirzada, Mrinalini Balki] L'arrêt cardiaque maternel dans un centre de soins tertiaires au cours de la période 1989-2011: une série de cas Purpose: To review and report maternal and neonatal outcomes after cardiac arrest during pregnancy in a large tertiary care centre and to consider steps to improve the outcomes. Clinical features: We performed a retrospective chart review of maternal cardiac arrest in the Mount Sinai Hospital, University of Toronto health records database for the period 1989-2011. Five cases were identified for an incidence of 1:24,883 deliveries (0.004%). Four of the five women were obese and older than 35yr. Two women had pre-existing cardiac conditions, and one had placenta accrete. All three underwent perimortem Cesarean delivery (PMCD), but none of these procedures was done within the recommended time of the "four-minute rule.” Two of the three women had repeated arrests and subsequently died. The other two women were in labour, received regional analgesia, and had assisted vaginal deliveries. Both of these patients survived, and all survivors (mothers and neonates) were neurologically intact. Four of five neonates survived. The etiology of the cardiac arrest was indeterminate in all five cases, although suspected amniotic fluid embolism was considered the most likely contributing factor in the majority of cases. Overall, the quality of the charting was inconsistent and incomplete. Conclusions: This series of five cases highlights the challenges to meeting the rule of initiating PMCD within four minutes of maternal cardiac arrest onset. We suggest focusing on the quality of ongoing resuscitation efforts and early delivery as our experience shows that mother and neonate can survive beyond five minutes after arrest. Improved documentation and creation of a national database for these rare events should be considered. Canadian Anesthesiologists' Society, 2013 Baghirzada Leyla Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Balki Mrinalini Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1077-1084 0832-610X 60:11<1077 2013 60 12630 https://doi.org/10.1007/s12630-013-0021-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-0021-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Baghirzada Leyla Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Balki Mrinalini Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1077-1084 0832-610X 60:11<1077 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer