A mother and her child were doing fine 3 years after the woman received therapeutic hypothermia following a cardiac arrest during pregnancy, a case report showed.
The woman had normal neurologic function and exercise capacity and a left ventricular ejection fraction exceeding 50%, according to Aakash Chauhan, MD, MBA, of Indiana University School of Medicine in South Bend, and colleagues.
And the child – a boy – had reached all of his neurodevelopmental milestones, the researchers reported online in the Annals of Emergency Medicine.
“The successful resuscitation of the mother and the successful birth of the fetus, with normal development at 36 months, adds further evidence to support the removal of pregnancy from the list of absolute contraindications for therapeutic hypothermia,” Chauhan and colleagues wrote.
Pregnant women have been excluded from pilot studies and clinical trials of therapeutic hypothermia, which has been shown to improve neurologic outcomes and reduce mortality among patients resuscitated from a cardiac arrest.
In addition, pregnancy generally was considered a contraindication to cooling until 2010 American Heart Association guidelines on cardiopulmonary resuscitation and emergency cardiovascular care, which did not say that pregnancy precluded use of the practice. A recent review, however, has maintained that pregnancy is a contraindication.
There are two case reports of pregnant women who were resuscitated and then treated with therapeutic hypothermia. Only one involved successful delivery of the fetus, as was seen in the current case.
The current case involved a previously healthy 33-year-old woman in the 20th week of pregnancy who suffered a cardiac arrest at a church gathering.
After the woman collapsed, a physician at the scene immediately began CPR and about 15 minutes later emergency medical services used an automated external defibrillator to convert her ventricular fibrillation to ventricular tachycardia. An advanced cardiac life support protocol was followed.
About 25 minutes after the arrest, the patient had a return to spontaneous circulation.
When the woman arrived at the emergency department, she had a Glasgow Coma Scale score of 3, indicating no motor, verbal, or eye opening responses. Sedation was maintained with propofol and fentanyl and paralysis was induced with vecuronium.
After a discussion among the clinical staff and a delay of 3 hours to allow for additional imaging studies, the patient underwent therapeutic hypothermia.
The delay “was a point of debate among the admitting physicians and consultants, and, in retrospect, hypothermia could have been achieved with the Arctic Sun 2000 Temperature Management System (Medivance, Louisville, Colo.) immediately in the emergency department,” the authors wrote.
Through the use of that system and cutaneous ice packs, the patient’s body temperature was brought down to 32.6º C (90.7º F) within 1 hour. Fetal shivering, which resolved when the mother was warmed to a normal temperature, was seen using ultrasonography.
The mother woke up on the second hospital day with some memory loss covering the minutes before the cardiac arrest and the first 2 days of the hospitalization. She received an implantable cardioverter-defibrillator on the seventh hospital day and was discharged on the tenth.
She returned to work 4 weeks after discharge and the rest of the pregnancy proceeded without any problems or restrictions. Her left ventricular ejection fraction was 25% at the 30th and 39th weeks of pregnancy.
At 39 weeks of gestation, the women delivered a healthy baby boy weighing 5 lbs. 15 oz.
At 3 years after the arrest, the mother’s cardiac and neurologic function were normal. She received a final diagnosis of cardiac arrest as a result of pregnancy-associated cardiomyopathy because there was no other apparent cause and her cardiac function improved after delivery.
At age 3, the child had normal scores on all domains of the Ages and Stages Questionnaire, Third Edition.
“The success of our case greatly depended on the appropriate timing of therapeutic interventions, efficient and effective coordination of multiple specialties, and an infrastructure with the appropriate resources to respond to acute cases such as this in an appropriate manner,” the authors wrote.
Primary source: Annals of Emergency Medicine
Source reference: Chauhan A, et al “The use of therapeutic hypothermia after cardiac arrest in a pregnant patient” Ann Emerg Med 2012; DOI: 10.1016/j.annemergmed.2012.06.004.