Frequency and Management of Maternal Peripartum Cardiac Arrest during Anesthetic Care: A Multicenter Retrospective Cohort Analysis

BACKGROUND: Previous studies describe maternal cardiac arrest as a rare and often preventable event, but details of clinical care are limited. This study sought to delineate the frequency, risk factors, etiology, and management of peripartum, perianesthetic maternal cardiac arrest in a large, contemporary U.S. cohort. METHODS: In this observational cohort study using the Multicenter Perioperative Outcomes Group database, the authors identified anesthetic records for delivery and up to 7 days postpartum for patients age 15 to 44 yr between 2015 and 2022. A screening algorithm using administrative data, anesthetic medications, electronic record concepts, and free-text notations identified potential cases of maternal cardiac arrest. Two independent reviewers conducted manual chart reviews to adjudicate the presence of cardiac arrest and to assess etiology, timing, management, and outcomes. The authors used descriptive statistics to assess associations between patient characteristics and cardiac arrest. RESULTS: Among 778,102 deliveries across 60 institutions, the authors identified 87 cardiac arrests during peripartum, perianesthetic care, corresponding to a frequency of 11.2 per 100,000 deliveries (95% CI, 9.1 to 13.8). The most common etiologies were hemorrhage (40.2%) and amniotic fluid embolism (31.0%); anesthetic complications ( e.g. , high neuraxial block) accounted for 11.5% of arrests. Most arrests occurred during cesarean deliveries (67.8%). Return of spontaneous circulation was achieved in 77.0% of patients; 67.8% survived to 30 days with a median postanesthetic hospital length of stay of 6 days. Demographic factors associated with arrest included age 40 yr or older, body mass index 40 kg/m 2 or higher, Black race, and Asian or Pacific Islander race. Clinical factors most strongly associated were pulmonary hypertension, placenta accreta spectrum, ischemic heart disease, and stillbirth. Potential deviations from societal cardiac arrest guidelines were identified in 18.4% of arrests. CONCLUSIONS: During peripartum anesthetic management in the United States, maternal cardiac arrests most commonly arise from hemorrhage and amniotic fluid embolism. These findings inform efforts to improve peripartum cardiac arrest guideline adherence and hemorrhage management.