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Maternal cardiac arrest rate in US hospitals higher than previously reported
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Among women hospitalized for childbirth, cardiac arrest occurs during approximately one of every 12,000 deliveries, which is twice the rate that had been previously reported in the literature, according to recent findings.
In a retrospective study, researchers obtained data on 56,900,512 hospitalizations for delivery recorded in the Nationwide Inpatient Sample between 1998 and 2011. They utilized patient-level discharge data to formulate weighted estimates of the number of these hospitalizations complicated by maternal cardiac arrest, as indicated by diagnostic and procedure codes. A multivariable model was created to account for maternal sociodemographic traits, conditions and procedures with independent correlations to maternal cardiopulmonary arrest. Evaluated variables included age, race/ethnicity, primary payer, maternal medical conditions and obstetric complications and procedures.
The primary outcome was population-based occurrence of cardiac arrest during hospitalization for delivery. Secondary outcomes included survival to hospital discharge; the relationship between maternal cardiac arrest and demographic/socioeconomic traits, diagnoses and procedures; and the correlation between maternal cardiac arrest and yearly delivery volume at the hospital.
Among the recorded hospitalizations, 4,843 cardiac arrest events occurred, equating to one in every 12,000 patients, or 8.5 per 100,000 patients (99% CI, 7.7-9.3 per 100,000). These events were most frequently related to hemorrhage, HF, amniotic fluid embolism and sepsis.
Medical conditions associated with arrest included CVD, liver disease, malignancy, pulmonary hypertension and systemic lupus erythematosus. Obstetric conditions linked to cardiac arrest included cesarean delivery, placenta previa, severe preeclampsia/eclampsia and stillbirth.
Of the patients who experienced cardiac arrest during delivery, 59% (99% CI, 54.9-63.1) survived to hospital discharge. Survival improved during the study period (P=.001) and was found to be contingent on the etiology of the cardiac arrest, with 74% of patients experiencing cardiac arrest having a coexisting diagnosis considered a potential etiology.
According to study investigator Jill M. Mhyre, MD, of the University of Arkansas for Medical Sciences, Little Rock, the survival rate observed in this study is higher than what has previously been reported in scientific literature.
"A 60% rate of survival from cardiac arrest is good, but maternal mortality in the United States remains unacceptably high," Mhyre said in a press release. "This information will assist health care providers to deliver the most effective maternal cardiopulmonary resuscitation when both the mother's and baby's lives are on the line."
Disclosure: The researchers report no relevant financial disclosures.
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