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C-section, Cardiac Arrest, Had Lost Pulse, Intubated, Defibrillator, On Life Support. Suggestion?

Posted on Sat, 29 Sep 2012

Question: my friend recently had a c-section.Immediately after birth she went into cariac arrest and had no pulse. She was intubated by the anesthesiologist and a code was called. A defibrillator was brought in and she was shocked. After 3 shocks heart beat was reestablished. The birth was recorded at 11:44 A.M. and the first shock was at 12:07 P.M. She has been on life support ever since. Should the OR have been equipped with a defibrillator or an AED? Should the OB/GYN and the anes made sure an AED was in the OR and they were properly trained in its use?

Answered by Dr. Kiran Kumar (20 hours later)

Hi,

You have mentioned that your friend had cardiac arrest soon after the delivery of the child by C - section. And then, she was intubated by the anesthesiologist and code was called.

It is an usual norm that all OR should be equipped with AED and I also suppose that it is present in the OR you are talking about.

However I am not sure about this, You need to confirm this with the doctor.

Both the Obstetrician and the anaesthetist should be well trained in it and also make sure that it is available all the time in the OR.

Few more questions to know more about your friend:

1. What was the initial Rhythm when patient had an arrest. Asystole or Ventricular Tachycardia/Ventricular Fibrillation (VF/VT).

In the former, shocks are not given and it is only in the latter that shocks are given.

Sometimes, patient can develop VF/VT during the course of resuscitation. In such cases shocks are given only then and not from beginning.

2. What were the sequence of events of the cardiac arrest ?

If there is a concern about delay in using the AED for shock, it is likely that the shock was required at 12:07 PM.

We would assume that the rhythm initially was non-shockable rhythm.

Hope this answers your query. I will be available for your follow up queries.

Thanks and Regards

Dr Kiran

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Kiran Kumar (6 days later)

The anesthesiologist's report states that the patient went into ventricular tachycardia. Also the code report indicates that the condition was VT at the time the code was called and at the time of each defribrillator use. The report of the staff doctor who was called from ICU states "apparently the patient bradied down, then was briefly asystolic and a code was called. By the time of my arrival to the Code, I observed a wide complex tachycardia. She had already been intubated by anesthesia who was there at the time. We gave the patient 1 ampule of magnesium sulfate and 300mg of amiodarone bolus after which the wide venticular tachycardia resolved and she reverted to sinus tachycardia with a narrow QRS complex. She was then transferred to ICU.

Answered by Dr. Kiran Kumar (14 hours later)

Hi again,

There seems to be discrepancy between the code report and ICU doctors report.

According to the details, code report mentions VT as the initial rhythm when code was called and according to ICU doctors report, she went into bradycardia and asystole.

Shocks are given only in VT ad not in bradycardia.

So I think they did follow the protocol. Medications given were appropriate.

Hope this answers your query.

Thanks and Regards.

Dr Kiran

Note: For further follow-up it is advisable to consult an emergency medicine specialist. Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E