Learning objectives
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Describe principles of Basic Life Support.
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Describe principles of Advanced Cardiovascular Life Support as they relate to pregnancy.
The goal of this chapter is to highlight pregnancy-related pearls with regards to maternal resuscitation. This section presupposes knowledge of Basic Life Support and Advanced Cardiovascular Life Support (ACLS) training. Please see your local training agency if you require formal training Fig. 4.1 shows the basic equipment needed for cardiopulmonary. The most important thing to remember is the “ABCs”—airway, breathing, and circulation as summarized in Fig. 4.2 .
Basic Life Support
Effective Chest Compressions (Fig. 4.3)
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Rate is 100–120 compressions per minute
Fig. 4.3
Proper technique for chest compression. Hands should be placed on the lower half of the sternum. Each compression should have a depth of 5–6 cm with full recoil between compressions.
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Compress the chest 5–6 cm (2–2.5 inches) with each downstroke
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Allow the chest to recoil completely after each downstroke
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To check adequacy → have another provider feel for femoral pulse during compressions
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Change the person doing compressions every 2–3 minutes to avoid fatigue
Ventilation
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Appropriate compression to ventilation ratio during CPR is 30 compressions to 2 breaths
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If an advanced airway is in place, give ventilations at a rate of approximately 10 per minute
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Ventilation rate can later be titrated based on blood gas values
Defibrillation ( Fig. 4.4 )
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Early defibrillation in patients with ventricular fibrillation improves outcomes
Fig. 4.4
Placement of defibrillator pads on right shoulder and left chest. The lateral pad should be placed under the patient’s breast tissue.
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Using the energy levels suggested by the manufacturer of the device—generally 360 J for a monophasic defibrillator and 200 J for a biphasic defibrillator
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Resume CPR immediately after defibrillation—do not stop to check for pulse
Advanced Cardiovascular Life Support
| Hypovolemia | Toxins |
| Hypoxia | Tamponade (cardiac) |
| Hydrogen ion (acidosis) | Tension pneumothorax |
| Hypoglycemia | Thrombosis |
| Hypothermia | Trauma |
General Pearls of Wisdom
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If you are giving any antiarrhythmic via a peripheral IV as opposed to a central line, raise the patient’s arm and flush with 20 mL of saline
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Try to identify and treat the underlying cause of the cardiac arrest using the classic mnemonic of the H’s and T’s ( Table 4.1 )
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Table 4.2 shows commonly needed medications
Considerations for ACLS in Pregnant Patients
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IV access should be established above the diaphragm
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Left uterine displacement improves venous return ( Fig. 4.5 )
