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Cardiac Arrest During Delivery Hospitalization
Quick Takes
- Cardiac arrest occurred in ~1 in 9,000 US delivery hospitalizations, and two thirds of these patients survived to hospital discharge.
- Cardiac arrest was more likely to occur in older patients who were Black, had Medicare or Medicaid, or had underlying medical conditions.
- Establishing clinical guidelines, ensuring that pregnant people receive risk-appropriate care, and addressing potential knowledge deficits in maternal cardiac arrest and CPR technique for pregnant people may improve maternal outcomes.
Study Questions:
What is the rate of, maternal characteristics associated with, and survival after cardiac arrest during delivery hospitalization?
Methods:
The investigators conducted a retrospective cohort study in US acute care hospitals from 2017–2019 and assessed delivery hospitalizations among women aged 12-55 years included in the National Inpatient Sample database. Delivery hospitalizations, cardiac arrest, underlying medical conditions, obstetric outcomes, and severe maternal complications were identified using codes from the International Classification of Diseases, 10th Revision, Clinical Modification. Survival to hospital discharge was based on discharge disposition. The authors calculated the weighted annual rate of cardiac arrest per 100,000 delivery hospitalizations and associated 95% confidence interval (CI) and assessed differences by examining 95% CIs.
Results:
Among 10,921,784 US delivery hospitalizations, the cardiac arrest rate was 13.4 per 100,000. Of the 1,465 patients who had cardiac arrest, 68.6% (95% CI, 63.2%-74.0%) survived to hospital discharge. Cardiac arrest was more common among patients who were older, were non-Hispanic Black, had Medicare or Medicaid, or had underlying medical conditions. Acute respiratory distress syndrome was the most common co-occurring diagnosis (56.0% [CI, 50.2%-61.7%]). Among co-occurring procedures or interventions examined, mechanical ventilation was the most common (53.2% [CI, 47.5%-59.0%]). The rate of survival to hospital discharge after cardiac arrest was lower with co-occurring disseminated intravascular coagulation (DIC) without or with transfusion (50.0% [CI, 35.8%-64.2%] or 54.3% [CI, 39.2%-69.5%], respectively).
Conclusions:
The authors report that cardiac arrest was observed in approximately 1 in 9,000 delivery hospitalizations, among which nearly 7 in 10 women survived to hospital discharge.
Perspective:
This analysis reports that during 2017–2019, cardiac arrest occurred in ~1 in 9,000 US delivery hospitalizations, and two thirds of these patients survived to hospital discharge. Of note, cardiac arrest was more likely to occur in older patients who were Black, had Medicare or Medicaid, or had underlying medical conditions. More information is needed on specific grounds of cardiac arrest frequency, including race and ethnicity; underlying medical conditions; and other patient-, hospital-, and community-level characteristics. Establishing clinical guidelines, ensuring that pregnant people receive risk-appropriate care, and addressing potential knowledge deficits in maternal cardiac arrest and cardiopulmonary resuscitation (CPR) technique for pregnant people may improve maternal outcomes.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Delivery, Obstetric, Disseminated Intravascular Coagulation, Ethnic Groups, Heart Arrest, Inpatients, Obstetric Labor Complications, Patient Discharge, Pregnancy, Secondary Prevention, Respiration, Artificial, Respiratory Distress Syndrome, Ventilators, Mechanical, Women
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