title: Management of cardiac arrest in pregnancy: a systematic review.
abstract: OBJECTIVE
  To describe the consensus on science pertaining to resuscitation of the pregnant patient.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  EMBASE, Ovid MEDLINE, Evidence Based Reviews, American Heart Association library and bibliographies of selected articles.
  
  
  METHODS
  The following inclusion criteria were used: pregnancy and cardiac arrest out of hospital, pregnancy and cardiac arrest in hospital, cardiovascular, respiratory, fetal survival, and pharmacology as they relate to cardiac arrest and resuscitation. Non-English papers, case reports and reviews were excluded. Studies were selected through an independent review of titles, abstracts and full article. Two reviewers independently graded the methodological quality of selected articles.
  
  
  RESULTS
  1305 articles were identified and 5 were selected for further review. There were no randomized trials and overall the quality of the selected studies was good. Two studies examined chest compressions on a manikin in left lateral tilt from the horizontal and concluded that although feasible with increasing degrees of tilt forcefulness of the chest compressions decreases. The third study observed the transthoracic impedance was not altered during pregnancy. One case series and one retrospective cohort study reviewed perimortem cesarean section. Both reports concluded that perimortem cesarean section is rarely done within the recommended time frame of 5 min after the onset of maternal cardiac arrest.
  
  
  CONCLUSIONS
  Usual defibrillation dosages are likely appropriate in pregnancy. Perimortem cesarean section is an intervention which is rarely done within 5 min to optimize maternal salvage from cardiac arrest. Chest compressions in left lateral tilt are less forceful compared to the supine position.
authors.affiliation: Department of Medicine, University of Toronto, Division of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada. farida.j@sympatico.ca
authors.forename: Farida M
authors.initials: FM
authors.lastname: Jeejeebhoy
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Zelop
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.forename: Jose C A
authors.initials: JC
authors.lastname: Carvalho
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D014481:United States / Q000453:epidemiology