Abstract
Introduction
Maternal mortality has risen in the United States during the 21st century. Factors
influencing outcome of maternal cardiac arrest (MCA) remain largely unexplored.
Objective
We sought to further elucidate the factors affecting maternal death from in-hospital
(IH) MCA.
Methods
Our query of the American Heart Association’s GWTG®-Resuscitation voluntary registry
from 2000–2017 revealed 561 index cases of IH MCA with complete outcome data. Logistic
regression was performed using hospital death as the primary outcome and included
variables with a p value = 0.1 or less based upon univariate analysis. Age, race,
year of arrest, pre-existing conditions, first documented pulseless rhythm and location
of arrest were used in the model. Sensitivity analyses and assessment of variable
interaction were also performed to test model stability. Institutional review deemed
this research exempt from ethical approval.
Results
Among 561 cases of MCA, 57.2% (321/561) did not survive to hospital discharge. IH
death was not associated with maternal age, race and year of event. In the final model,
IH death was significantly associated with pre-arrest hypotension/hypoperfusion (OR
= 1.80 (95% CI, 1.16–2.79); p = 0.009). The occurrence of MCA outside of the delivery
suite (referent group) or operating room was associated with a significantly higher
risk of death: ICU/Post-Anesthesia Care Unit (PACU) (OR = 3.32 (95% CI, 2.00–5.52);
p < 0.001) and ER/other (OR = 1.89 (95% CI, 1.15–3.11); p = 0.012). While MCA cases
with a shockable vs. non-shockable first documented pulseless rhythm had similar outcomes,
those with an indeterminate rhythm were less likely to die, (OR = 0.41(95% CI, 0.20–0.84);
p = 0.014). In a sensitivity analysis, removal of the indeterminate group did not
alter outcomes regarding first documented pulseless rhythm or arrest location. Area
under the curve for the final model was 0.715 (95% CI 0.673–0.757).
Conclusions
Our study identified several novel factors associated with IH death of our MCA cohort.
More research is required to further understand the pathophysiologic dynamics affecting
outcomes of IH MCA in this unique population.
Keywords
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Article info
Publication history
Published online: May 15, 2021
Accepted:
April 26,
2021
Received in revised form:
April 12,
2021
Received:
February 6,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
