Cardiac arrest and resuscitative cesarean section – A brief review

Abstract

Maternal cardiac arrest is a life-threatening event with both obstetric and non-obstetric causes, requiring rapid, pregnancy-specific resuscitation. Physiological changes in pregnancy reduce the effectiveness of standard Cardiopulmonary resuscitation, necessitating modifications to advanced cardiac life support (ACLS). This review aims to highlight key causes, resuscitation adaptations, and the critical role of perimortem cesarean delivery (PMCD) in improving maternal and fetal outcomes. A structured literature search was conducted across PubMed, Scopus, Google Scholar, and Web of Science using relevant keywords. Studies were screened by title/abstract followed by full-text review, and articles focusing on clinical aspects, techniques, outcomes, and guidelines of PMCD were included, with emphasis on recent high-quality evidence. The literature search included peer-reviewed publications from 2000 to 2025, comprising original research articles, case reports, and guideline documents. Resuscitation follows standard American Heart Association (AHA) basic life support (BLS)/ ACLS with key modifications: provide left uterine displacement (LUD) (15–30° tilt) after 20 weeks to relieve aortocaval compression; secure airway early due to difficult airway and rapid desaturation; perform chest compressions slightly higher on the sternum; use upper-extremity/central venous access; and apply standard defibrillation and drug protocols. If PMCD is performed within 5 min of cardiac arrest, it significantly improves maternal return of spontaneous circulation (ROSC) and increases the likelihood of favorable fetal survival and neurological outcomes. Maternal cardiac arrest requires prompt, pregnancy-specific modifications to standard resuscitation to optimize outcomes. Early uterine displacement, effective airway management, and adherence to ACLS protocols are critical, while timely PMCD within 4–5 min significantly improves maternal hemodynamics and enhances both maternal and fetal survival.