Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Valley Hospital, Ridgewood, NJ, USA; Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA.
Surgical Intensive Care, Shaare Zedek Medical Center, Samuel Byte 12, Jerusalem 9103102, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel.
Resuscitation. 2018 Nov;132:17-20. doi: 10.1016/j.resuscitation.2018.08.029. Epub 2018 Aug 28.
Maternal mortality has risen in the United States in the twenty-first century, yet large cohort data of maternal cardiac arrest (MCA) are limited.
We sought to describe contemporary characteristics and outcomes of in-hospital MCA.
We queried the American Heart Association's Get with the Guidelines Resuscitation voluntary registry from 2000 to 2016 to identify cases of maternal cardiac arrest. All index cardiac arrests occurring in women aged 18-50 with a patient illness category designated as obstetric or location of arrest occurring in a delivery suite were included. Institutional review deemed that this research was exempt from ethical approval.
A total of 462 index events met criteria for MCA, with a mean age of 31 ± 7 years and a racial distribution of: 49.4% White, 35.3% Black and 15.3% Other/Unknown. While 32% had no pre-existing conditions or physiologic disorders, respiratory insufficiency (36.1%) and hypotension/hypoperfusion (33.3%) were the most common antecedent conditions. In most cases, the first documented pulseless rhythm was non-shockable; pulseless electrical activity (50.8%) or asystole (25.6%). Only 11.7% presented with a shockable rhythm; ventricular fibrillation (6.5%) or pulseless ventricular tachycardia (5.2%) while the initial pulseless rhythm was unknown in 11.9% of cases. Return of spontaneous circulation occurred in 73.6% but 68 (14.7%) had more than one arrest. The rate of survival to discharge was 40.7% overall; 37.3% with non-shockable rhythms, 33% with shockable rhythms and 64.3% with unknown presenting rhythms.
Maternal survival at hospital discharge in this cohort was less than 50%, lower than rates reported in other epidemiological datasets. More research is required in maternal resuscitation science and translational medicine to continue to improve outcomes and understand maternal mortality.
在 21 世纪，美国的产妇死亡率有所上升，但关于产妇心搏骤停（MCA）的大型队列数据有限。
我们旨在描述院内 MCA 的当代特征和结局。
我们在美国心脏协会的 Get with the Guidelines Resuscitation 自愿注册库中检索了 2000 年至 2016 年期间的病例，以确定产妇心搏骤停的病例。所有符合以下标准的索引心搏骤停均被纳入研究：年龄在 18-50 岁的女性，患者疾病类别为产科，或发病地点在产房。机构审查认为，这项研究无需伦理批准。
共有 462 例符合 MCA 标准的索引事件，平均年龄为 31±7 岁，种族分布为：49.4%为白人，35.3%为黑人，15.3%为其他/未知。尽管 32%的患者无既往疾病或生理障碍，但呼吸功能不全（36.1%）和低血压/灌注不足（33.3%）是最常见的前驱疾病。在大多数情况下，首次记录的无脉节律是非可电击性的；无脉电活动（50.8%）或心搏停止（25.6%）。仅有 11.7%的患者呈现可电击性节律；室颤（6.5%）或无脉性室性心动过速（5.2%），而 11.9%的患者初始无脉节律未知。自主循环恢复发生在 73.6%的患者中，但 68 例（14.7%）发生了不止一次心搏骤停。总体存活率出院率为 40.7%；无脉节律者为 37.3%，可电击性节律者为 33%，初始无脉节律者为 64.3%。
本队列中产妇出院时的存活率低于 50%，低于其他流行病学数据集中的报告率。需要在产妇复苏科学和转化医学方面进行更多研究，以继续改善结局并了解产妇死亡率。
