Cardiac Arrest in Pregnancy: End-Tidal CO2 Monitoring Could Guide Management in the Prehospital Setting

Abstract

This case report describes a 27-year-old pregnant woman with a gestational age of 26 weeks and 3 days who developed cardiac arrest in her home. Resuscitation was started immediately and continued on arrival at the hospital. Guidelines for resuscitation of cardiac arrest during pregnancy in-hospital include that a perimortem caesarean section (PMCS) should be performed if there is no return of spontaneous circulation within 4 minutes. The guidelines for prehospital treatment in such circumstances are more controversial. The triage on-site was based on the end-tidal carbon dioxide (ETCO2) monitoring showing that the quality of resuscitation being done was proficient and after a short on-scene time the patient was transported to the emergency department for PMCS on arrival. The resuscitation of the mother was not successful but the baby survived with no known sequelae after a total arrest time of 28 minutes before delivery. Monitoring of ETCO2 in resuscitation of cardiac arrest in pregnancy might be helpful in making the decision on whether to perform PMCS on-site or at a somewhat more appropriate location in the hospital.