Cardiac arrest with co-occurring DIC tied to lowest Survival

A new study published in Annals of Internal Medicine suggests that 1 in 9000 hospital deliveries have cardiac arrest, however almost 7 out of 10 of the mothers were able to leave the hospital.

Predictions of cardiac arrest during birth inform the development of evidence-based prevention measures for fatalities associated with pregnancy. The purpose of this study, which was carried out by Nicole Ford and colleagues, was to determine the prevalence of maternal features linked to cardiac arrest during delivery as well as survival.

This retrospective cohort analysis includes data from acute care hospitals in the United States from 2017 to 2019. The major exposure of this investigation were hospitalizations for deliveries among women between the ages of 12 and 55 who were included in the National Inpatient Sample database. The International Classification of Diseases, 10th Edition, Clinical Modification codes were used to identify hospitalizations for delivery, underlying medical problems, cardiac arrest, obstetric outcomes, and severe maternal complications. Based on discharge disposition, survival to hospital discharge was calculated.

The key findings of this study were:

1. The cardiac arrest rate among 10 921 784 hospital deliveries in the United States was 13.4 per 100,000. 68.6% (95% CI, 63.2% to 74.0%) of the 1465 patients who had cardiac arrest lived to be discharged from the hospital.

2. Patients who were non-Hispanic Black, older, had Medicare or Medicaid, or had underlying medical issues experienced cardiac arrest more frequently.

3. The most frequent co-occurring diagnosis was acute respiratory distress syndrome (56.0% [CI, 50.2% to 61.7%]).

4. Mechanical breathing was the most prevalent co-occurring procedure or intervention (53.2% [CI, 47.5% to 59.0%]).

5. For co-occurring disseminated intravascular coagulation (DIC) without or with transfusion, the percentage of survival to hospital discharge after cardiac arrest was lower (50.0% [CI, 35.8% to 64.2%] or 54.3% [CI, 39.2% to 69.5%], respectively).

Reference:

Ford, N. D., DeSisto, C. L., Galang, R. R., Kuklina, E. V., Sperling, L. S., & Ko, J. Y. (2023). Cardiac Arrest During Delivery Hospitalization. In Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m22-2750