(400) Maternal and Neonatal Outcomes Following Maternal Cardiac Arrest

Objective: Maternal cardiac arrest is an uncommon but catastrophic event. We sought to define the maternal and neonatal outcomes associated with maternal code at our public tertiary care center.

Study Design: This is a single-institution retrospective cohort study of cases of maternal cardiac arrest from 2010 through 2024 at a large county hospital. Demographics and data regarding maternal code events, delivery, and neonatal outcomes were obtained from the medical record. All cases of maternal codes in the setting of pregnancy or within six months postpartum were included. A descriptive statistical analysis was completed.

Results: Thirty-eight maternal codes were identified during the study timeframe, with 169,848 deliveries, this is consistent with 2 per 10,000 births. Of the 38 cases, 6 occurred at a gestational age of less than 20 weeks. Thirty-five codes occurred in the hospital with 25 (71%) resulting in return of spontaneous circulation (ROSC). Of the 3 cases of cardiac arrest outside of the hospital, only one patient survived. Overall, 23 individuals (61%) survived until discharge with an average length of stay of 18.2 days. For survivors, ROSC was achieved within 5 minutes in 74%. Eleven of the 38 individuals had a live fetus at 24 weeks or greater at the time of code. A resuscitative hysterotomy occurred in 9 out of 11 (82%) with a median time from code to delivery of 4 minutes. All of the neonates who underwent resuscitative hysterotomy survived until discharge. NICU admission occurred in the majority (78%), with 44% requiring mechanical ventilation and 33% complicated by hypoxic-ischemic encephalopathy. An additional 13 patients experienced a code in the immediate peripartum period with a median time from delivery to maternal code of 22 minutes.

Conclusion: Despite the infrequent and high acuity nature of maternal codes, achievement of ROSC and survival remains high, especially in the event of in-hospital cardiac arrest. Rapid delivery of the neonate, within four minutes of maternal code, was associated with a high likelihood of neonatal survival in the setting of viability.