ACLS In-Hospital Cardiac Arrest in Pregnancy Algorithm

Cardiac arrest that occurs in the hospital is handled differently than it is in other adults in some important ways. Cardiac arrest resuscitation of pregnant women focuses on resuscitating the mother primarily. Fetal monitoring should not be used during cardiac arrest in pregnant women, and if fetal monitors were in place, they should be removed during resuscitation. When possible, a specialized maternal cardiac arrest team should conduct the resuscitation. This team can take over for the first ACLS providers on the scene if they are not part of the maternal cardiac arrest team. Since pregnant women are more likely to have hypoxia in general, oxygenation and airway management should be prioritized over circulation, in some respects, like it is in the care of pediatric patients.

1. Perform BLS/ACLS as would occur in any adult patient
2. When possible, hand off care to the maternal cardiac arrest team
3. For the mother:
   1. Support the airway and provide one breath every 6 seconds
   2. Give 100% oxygen
   3. If magnesium is being administered, stop it, and provide calcium chloride or calcium gluconate
4. For the fetus:
   1. Relieve aortocaval compression by moving the uterus laterally
   2. Detach or do not use fetal monitors
   3. Prepare for Cesarean delivery
5. If ROSC occurs, move to post-cardiac arrest care
6. Pregnant women who remain comatose after resuscitation from cardiac arrest should receive targeted temperature management and fetal heart rate monitoring with OB/GYN support
7. If ROSC does not occur within 5 minutes, consider perimortem Cesarean delivery
   1. The neonate should be evaluated for neonatal resuscitation