Post-cardiopulmonary resuscitation therapeutic hypothermia during the immediate post-partum period in a patient seen at San Jose Hospital in Bogota in 2013: Case Report and review of the literature
DOI:
https://doi.org/10.18597/rcog.19Keywords:
Therapeutic hypothermia, cardiac arrest, post-partum, pregnancyAbstract
Objective: To report the case of a patient who went into cardiac arrest in the immediate post-partum period and was managed with post-resuscitation
therapeutic hypothermia with a favourable neurologic outcome; and to conduct a review of the published literature on post-resuscitation hypothermia in pregnancy.
Materials and methods: We present the case of a patient in her 37th week of gestation, referred because of severe pre-eclampsia to a private, level IV institution in Bogotá, Colombia. The patient underwent cesarean section and during childbirth she developed eclampsia with respiratory distress, hypoxemia and bradycardia that progressed to cardiac arrest in asystole. Sinus rhythm returned after 15 minutes of cardiopulmonary resuscitation (CPR) but the patient was in a status consistent with residual coma. A neuroprotection protocol was initiated with hypothermia, maintained at 33 degrees over a 24-hour period, and then followed by gradual warming. The final outcome was favourable, with recovery of consciousness and negligible motor sequelae.
For the review of the literature, a search was conducted in Medline via the PubMed and Embase databases using MESH terms for the key words
therapeutic hypothermia, pregnancy, cardiac arrest, with no restriction of language or time.
Results: Overall, 4 studies that met the search criteria were found in PubMed. In Embase, 7 referred to the topic, including the 4 case reports already found in PubMed plus two additional case reports and a review of maternal cardiac
arrest that discusses therapeutic hypothermia in this population. The review of the bibliographic references resulted in the identification of a clinical practice guideline and one additional review article.
Conclusions: Therapeutic hypothermia is described in the published literature as a beneficial therapy that could be considered part of postcardiac arrest care as a measure of neurological protection in the pregnant patient. Studies with
larger numbers of patients and controlled trials to assess the effectiveness and safety of the technique for the mother and the foetus are needed.
Author Biographies
Daniel Molano-Franco
Antonio Oyola-Yepes
Víctor Nieto-Estrada
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