Cardiac arrest not uncommon during delivery hospitalization

One cardiac arrest occurs for every 9,000 delivery hospitalizations, among which about seven in 10 women survive to be discharged from the hospital, according to a study. In addition, survival is lowest during hospitalizations with co-occurring disseminated intravascular coagulation (DIC).

A retrospective cohort study was conducted in US acute care hospital from 2017 to 2019 to investigate the rate of, maternal characteristic associated with, and survival after cardiac arrest during delivery hospitalizations among women aged 12‒55 years included in the National Inpatient Sample database.

The authors identified delivery hospitalizations, cardiac arrest, underlying medical conditions, obstetric outcomes, and severe maternal complications using codes from the International Classification of Diseases, 10th Revision, Clinical Modification. Survival to hospital discharge was based on discharge disposition.

The rate of cardiac arrest among 10,921,784 US delivery hospitalizations was 13.4 per 100,000. A total of 1,465 patients had cardiac arrest, of whom majority (68.6 percent, 95 percent confidence interval [CI], 63.2‒74.0) survived to hospital discharge.

Cardiac arrest occurred more frequently among patients who were older, non-Hispanic Black, had Medicare or Medicaid, or had underlying medical conditions. The most common co-occurring diagnosis was acute respiratory distress syndrome (56.0 percent, 95 percent CI, 50.2‒61.7), while the most common procedure or intervention was mechanical ventilation (53.2 percent, 95 percent CI, 47.5‒59.0).

Survival to hospital discharge after cardiac arrest was poorer among patients with co-occurring IDC with (54.3 percent, 95 percent CI, 35.8‒64.2) or without transfusion (50.0 percent, 95 percent CI, 35.8‒64.2).

The authors, however, did not include cardiac arrests that occurred outside delivery hospitalizations. Other limitations included the unknown temporality of arrest relative to the delivery or other maternal complications, as well as data that did not distinguish the cause of cardiac arrest, such as pregnancy-related complications or other underlying cause among pregnant women.