Resucitación cardiopulmonar y cerebral en la embarazada. Al final del colapso materno

  • Mauricio Vasco-Ramírez

Resumen

Objetivo: proporcionar a los profesionales de la salud involucrados en el manejo de gestantes con complicaciones (obstetras, enfermeras, médicos generales y de emergencias, anestesiólogos, intensivistas, entre otros) los principios fundamentales de prevención y manejo de paro cardiorrespiratorio (PCR) en este grupo poblacional con el fin de mejorar los resultados del binomio madre-hijo.

Materiales y métodos: el documento se basa en una búsqueda de publicaciones en las bases de datos Medline, SciELO y Embase utilizando los términos "Cardiopulmonary Resuscitation, Pregnancy, Perimortem Cesarean, Maternal Cardiac Arrest, Cardiac arrest in pregnancy", y restringida a los siguientes tipos de publicación: "Meta Analysis, Systematic Reviews, Practice Guideline, Randomized Controlled Trial, Review, Case Report, Chapter, Editorial, Survey".

Resultados: se encontraron 78 títulos de los cuales se incluyeron 63; de estos, 22 corresponden a revisiones narrativas, 20 a reportes y series de caso, 8 a guías de práctica clínica, 5 a ensayos clínicos, 4 editoriales, 2 corresponden a revisiones sistemáticas o metaanálisis, 1 capítulo de libro y 1 encuesta o survey.

Conclusiones: el paro cardiaco en gestantes impone un reto al grupo interdisciplinario que lo enfrenta, por ser una entidad de baja frecuencia que se puede asociar a un alto grado de morbimortalidad materna y perinatal. Las principales acciones por realizar son: activación del código azul obstétrico con respuesta adecuada para realización de histerotomía de emergencia oportuna, compresiones torácicas de buena calidad, desviación manual uterina 15º a la izquierda cuando el útero grávido se palpe por encima del ombligo materno, manejo avanzado farmacológico y de vía aérea, y cuidado óptimo luego de la resucitación para la madre y el neonato.

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Biografía del autor/a

Mauricio Vasco-Ramírez
Especialista en Anestesiología, Cuidados Intensivos y Reanimación, Universidad Pontificia Bolivariana, Medellín (Colombia). Coordinador del Comité de Anestesia Obstétrica, Sociedad Colombiana de Anestesiología y Reanimación (SCARE). Coordinador para América Latina de la Comisión de Anestesia Obstétrica, Confederación Latinoamericana de Sociedades de Anestesia (CLASA) y Federación Mundial de Sociedades de Anestesia (WFSA). Miembro Honorario de la Federación Colombiana de Obstetricia y Ginecología (FECOLSOG), Bogotá (Colombia)

Referencias bibliográficas

Vasco M. Resucitación cardiopulmonar en la embarazada. Rev Col Anest. 2004; 32:243-51.

Navarro Vargas R. Manual de reanimación básica. Guía para el entrenamiento del estudiante. Bogotá: Sociedad Colombiana de Anestesiología y Reanimación; 2011.

Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ et al. Part 12: Cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonar y Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl. 3):S829-861.

Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2010: Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81:1400-33.

ACLS for experienced providers. Cardiac Arrest associated with pregnancy. American Heart Association; 2003. p. 143-149.

Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, et al. Part 8: advanced life support: 2010 International Consensus on Cardiopulmonar y Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2010;122(16 Suppl. 2): S345-421.

Gosman GG, Baldisseri MR, Stein KL, Nelson TA, Pedaline SH, Waters JH, et al. Introduction of an obstetric specific medical emergency team for obstetric crises: implementation and experience. Am J Obstet Gynecol. 2008;198:367.

Maternal Collapse in Pregnancy and the Puerperium. [Visitado 2013 Ene 15]. Disponible en: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg56/

Singh S, McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia. 2012;67:12-8.

Rojas JA, González M, Monsalve G, Escobar MF, Vasco M. Consenso colombiano para la definición de los criterios de ingreso a unidades de cuidados intensivos en la paciente embarazada críticamente enferma. Rev Colomb Obstet Ginecol. 2014;65:47-74.

Ezri T, Lurie S, Weiniger CF, Golan A, Evron S. Cardiopulmonar y resuscitation in the pregnant patient--an update. Isr Med Assoc J. 2011;13:306-10.

Farinelli CK, Hameed AB. Cardiopulmonar y resuscitation in pregnancy. Cardiol Clin. 2012;30: 453-61.

Sommerkamp SK, Gibson A. Cardiovascular disasters in pregnancy. Emerg Med Clin North Am. 2012;30:949-59.

Hui D, Morrison LJ, Windrim R, Lausman AY, Hawryluck L, Dorian P, et al. The American Heart Association 2010 guidelines for the management of cardiac arrest in pregnancy: consensus recommendations on implementation strategies. J Obstet Gynaecol Can. 2011;33:858-63.

Schimmelpfennig K, Stanfill TJ. Advanced cardiovascular life support for the obstetric population: bridging the gap. J Perinat Neonatal Nurs. 2012;26:136-46.

Puck AL, Oakeson AM, Morales-Clark A, Druzin M. Obstetric life support. J Perinat Neonatal Nurs. 2012;26:126-35.

Jones R, Baird SM, Thurman S, Gaskin IM. Maternal cardiac arrest: an overview. J Perinat Neonatal Nurs. 2012;26:117-23

van Waning VH, van der Weiden RM, de Feiter PW, Brouwers AJ. Cardiac arrest in pregnancy: lessons to be learned! Intensive Care Med. 2012;38:721.

Ramsay G, Paglia M, Bourjeily G. When the Heart Stops: A Review of Cardiac Arrest in Pregnancy. J Intensive Care Med. 2013;28:204-14.

Campbell TA, Sanson TG. Cardiac arrest and pregnancy. J Emerg Trauma Shock. 2009;2:34-42.

Lipman S, Cohen S, Einav S, Jeejeebhoy F, Mhyre JM, Morrison LJ, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesth Analg. 2014;118:1003-16.

Mhyre JM, Tsen LC, Einav S, Kuklina EV, Leffert LR, Bateman BT. Cardiac Arrest during Hospitalization for Deliver y in the United States, 1998-2011. Anesthesiology. 2014;120:810-8.

Morrison LJ, Jeejeebhoy FM. Estimating Maternal Card iac Ar rest In c id en c e an d Out c omes . Anesthesiology 2014;120:790-1.

Jeejeebhoy FM, Zelop CM, Windrim R, Carvalho JC, Dorian P, Morrison LJ. Management of cardiac arrest in pregnancy: a systematic review. Resuscitation. 2011;82:801-9.

King SE, Gabbott DA. Maternal cardiac arrest rarely occurs, rarely researched. Resuscitation. 2011;82: 795-6.

Morris S, Stacey M. Resuscitation in pregnancy. BMJ.2003;327:1277-79.

Whitty JE. Maternal Cardiac Arrest in Pregnancy. Clin Obstet Ginecol. 2002;45:377-92.

Suresh MS, LaToya Mason C, Munnur U. Cardiopulmonary resuscitation and the parturient. Best Pract Res Clin Obstet Gynaecol. 2010;24:383-400.

Kinsella SM. Lateral tilt for pregnant women: why 15 degrees? Anaesthesia. 2003;58:835-6.

Nanson JD, Elcock D, Williams M, et al. Do physiological changes in pregnancy change defibrillation energy requirements? Br J Anaesth 2001;87:237-9.

Karpati P, Rossignol M, Pirot M, Cholley B, Vicaut E, Henry P, et al. High Incidence of Myocardial Ischemia during postpartum Hemorrhage. Anesthesiology. 2004;100:30-6.

Borrás R, Perinan R, Fernández C, Plaza A, Andreud E, Schmucker E, et al. Airway management algorithm in the obstetrics patient. Rev Esp Anestesiol Reanim. 2012;59:436-43.

Mhyre JM, Healy D. The Unanticipated Difficult Intubation in Obstetrics. Anesth Analg. 2011;112: 648-52.

Knill RL. Difficult laryngoscopy made easy with a "BURP". Can J Anaesth. 1993;40:279-82.

Wenk M, Pöpping DM, Hillyard S, Albers H, Möllmann M. Intraoperative thrombolysis in a patient with cardiopulmonary arrest undergoing caesarean delivery. Anaesth Intensive Care. 2011;39:671-4.

Chauhan A, Musunuru H, Donnino M, McCurdy MT, Chauhan V, Walsh M. The use of therapeutic hypothermia after cardiac arrest in a pregnant patient. Ann Emerg Med. 2012;60:786-9.

Rittenberger JC, Kelly E, Jang D, Greer K, Heffner A. Successful outcome utilizing hypothermia after cardiac arrest in pregnancy: a case report. Crit Care Med. 2008;36:1354-6.

Bern S, Weinberg G. Local anesthetic toxicity and lipid resuscitation in pregnancy. Curr Opin Anaesthesiol. 2011;24:262-7.

Toledo P. The role of lipid emulsion during advanced cardiac life support for local anesthetic toxicity. Int J Obstet Anesth. 2011;20:60-3.

Williamson RM, Haines J. Availability of lipid emulsion in obstetric anaesthesia in the UK: a national questionnaire survey. Anaesthesia. 2008;63:385-8.

Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK Randomized Controlled Trial Comparing Traditional with two "Mobile" Epidural techniques Anesthetic and Analgesic Efficacy. Anesthesiology 2002;97:1567-75.

Bonner JC, McClymont W. Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2012;67:538-40.

Marr R, Hyams J, Bythell V. Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2013;68: 283-7.

Katz V. Cesarean deliver y: a reconsideration of terminology. Obstet Gynecol. 1995;86:152-3.

Katz V, Balderston K, DeFreest M. Perimorten caesarean delivery: Were our assumptions correct? Am J Obstet Gynecol. 2005;192:1916-21.

Katz VL, Dotters DJ, Droegemueller W. Perimortem cesarean delivery. Obstet Gynecol. 1986;68:571-6.

Vencken PM, van Hooff MH, van der Weiden RM. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG. 2010;117:1664-5.

Engels PT, Caddy SC, Jiwa G, Douglas Matheson J. Cardiac arrest in pregnancy and perimortem cesarean delivery: case report and discussion. CJEM. 2011;13:399-403.

Whitty JE. Maternal cardiac arrest in pregnancy. Clin Obstet Gynecol. 2002;45:377-92.

Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonar y Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(16 Suppl 2):S516-38.

Katz VL. Perimortem cesarean delivery: its role in maternal mortality. Semin Perinatol. 2012; 36:68-72.

Jeejeebhoy F, Windrim R. Management of cardiac arrest in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2014;28:607-18.

McDonnell NJ. Cardiopulmonary arrest in pregnancy: two case reports of successful outcomes in association with perimortem caesarean delivery. Br J Anaesth. 2009;103:406-9.

Zdolsek HJ, Holmgren S, Wedenberg K, Lennmarken C. Circulatory arrest in late pregnancy: caesarean section a vital decision for both mother and child. Acta Anaesthesiol Scand. 2009;53:828-9.

Ecker JL, Solt K, Fitzsimons MG, MacGillivray TE. Case records of the Massachusetts General Hospital. Case 40-2012. A 43-year-old woman with cardiorespiratory arrest after a cesarean section. N Engl J Med. 2012;367:2528-36.

Kim S, You JS, Lee HS, Lee JH, Park YS, Chung SP. Park I. Quality of chest compressions performed by inexperienced rescuers in simulated cardiac arrest associated with pregnancy. Resuscitation. 2013;84: 98-102.

Lipman SS, Wong JY, Arafeh J, Cohen SE, Carvalho B. Transport decreases the quality of cardiopulmonary resuscitation during simulated maternal cardiac arrest. Anesth Analg. 2013;116:162-7.

Lipman S, Daniels K, Cohen SE, Carvalho B. Labor room setting compared with the operating room for simulated perimortem cesarean delivery: a randomized controlled trial. Obstet Gynecol. 2011;118:1090-4.

Hards A, Davies S, Salman A, Erik-Soussi M, Balki M. Management of simulated maternal cardiac arrest by residents: didactic teaching versus electronic learning. Can J Anaesth. 2012;59:852-60.

Berkenstadt H, Ben-Menachem E, Dach R, Ezri T, Ziv A, Rubin O, et al. Deficits in the provision of cardiopulmonar y resuscitation during simulated obstetric crises: results from the Israeli Board of Anesthesiologists. Anesth Analg. 2012;115:1122-6.

Fisher N, Eisen LA, Bayya JV, Dulu A, Bernstein PS, Merkatz IR, Goffman D. Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training. Am J Obstet Gynecol. 2011;205:239.e1-5.

Lipman SS, Daniels KI, Arafeh J, Halamek LP. The case for OBLS: a simulation-based obstetric life support program. Semin Perinatol. 2011;35:74-9.

Lipman SS, Daniels KI, Car valho B, Arafeh J, Harney K, Puck A, et al. Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises. Am J Obstet Gynecol. 2010;203: 179.e1-5.

Vasco M. Estrategias de manejo mediante competencias no técnicas para la disminución de la morbimortalidad materna y perinatal. Rev colomb anestesiol. 2013; 41:20-3.

Publicado
2014-09-30
Cómo citar
1.
Vasco-Ramírez M. Resucitación cardiopulmonar y cerebral en la embarazada. Al final del colapso materno. Rev. Colomb. Obstet. Ginecol. [Internet]. 30 de septiembre de 2014 [citado 4 de agosto de 2021];65(3):228-42. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/50
Sección
Educación Médica