Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses

BMC Pregnancy and Childbirth

Tomoyuki Yamashita¹  Marie Furuta²  Naosuke Enomoto³  Hiroaki Tanaka³  Shigetaka Matsunaga⁴  Atsushi Sakurai⁵  Edmond S. W. Ng⁶ 

[1] Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Tokyo, Japan;Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan;Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, 514-8507, Tsu, Mie, Japan;Department of Obstetrics and Gynaecology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan;Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan;London School of Hygiene & Tropical Medicine, London, UK;

关键词: Maternal cardiac arrest;    Cardiopulmonary resuscitation;    Pregnant women;    Patient positioning;   

DOI  :  10.1186/s12884-021-04334-y

来源: Springer

【 摘 要 】

BackgroundAlthough rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective.MethodsWe searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations.ResultsWe included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°–30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position.ConclusionsGiven that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest.

【 授权许可】

CC BY