Peri-mortem caesarean section after traumatic arrest: Crisis resource management

• Published in: The American journal of emergency medicine Vol. 36; no. 12; pp. 2338.e1 - 2338.e3
• Main Authors: Ng, Wei Ming, Lee, Wei Feng, Cheah, Si Oon, Chung, Yan Ee Lynette, Lee, Chan Yu, Lim, Beng Leong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2018; Elsevier Limited
• Subjects: Age; Antifibrinolytic agents; Blood transfusion; Cardiopulmonary resuscitation; Catheters; CPR; Emergency medical care; Emergency medical services; Emergency procedures; Epinephrine; Fetuses; Hypothermia; Intravenous administration; Intubation; Lifesaving; Medical materials; Motor vehicles; Neonates; Peri-mortem caesarean section; Resource management; Survival; Traumatic arrest; Umbilical vein; Umbilicus; Veins & arteries; Peri-mortem caesarean section; Traumatic arrest
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.08.078

Peri-mortem caesarean section (PMCS) is a very rare procedure performed to improve the chances of survival for both mother and fetus following cardiorespiratory arrest. Non-obstetricians including Emergency Physicians (EPs) are often called upon to perform this procedure under challenging and suboptimal circumstances. We reported a case of PMCS performed timely after traumatic cardiorespiratory arrest that resulted in fetal survival.
A 25-year-old primigravida female and six-month pregnant presented to the Emergency Department (ED) of an adult tertiary hospital. She experienced traumatic cardiorespiratory arrest for nearly 27 min following a high-speed motor vehicle crash. Upon ED arrival, she was in pulseless electrical activity. She was immediately intubated with continuation of cardiopulmonary resuscitation. She received bilateral tube thoracostomies as well as intravenous (IV) transfusion of blood products, adrenaline and tranexamic acid. Her fundal height was two centimeters above the umbilicus on palpation. The EP performed a PMCS via a midline laparotomy 3–4 min upon ED arrival. The baby was bradycardic and cyanosed with no spontaneous respiration at birth and was resuscitated by a second EP. She was intubated and the EP gained IV access using a cannula introduced into the umbilical vein. Neonatal hypothermia was avoided using cling wrap. The baby was transported to a nearby neonatal intensive unit. She survived and is currently one year old.
The mother, however, did not respond to our resuscitation and succumbed to her multiple injuries.
We reviewed the limited literature regarding this potentially life-saving emergency procedure and highlighted the challenges facing our resuscitation team.