Feature | July 13, 2012

The Offbeat: Baby Not Harmed by Therapeutic Hypothermia During Pregnant Woman's Cardiac Arrest

July 13, 2012 ? An otherwise healthy pregnant woman who suffered cardiac arrest and was resuscitated, therapeutically cooled and then re-warmed, delivered a healthy, full-term baby 19 weeks later. Researchers published a unique case report online last week in Annals of Emergency Medicine.

"We have over years years of clinical follow-up of the mother and child and both are doing well, with the child exhibiting normal developmental growth at long-term follow-up," said lead author Aakash Chauhan, M.D., MBA, of Allegheny General Hospital in Pittsburgh, Penn. "The mother and child both had great outcomes despite an incredibly harrowing episode during her pregnancy."

The patient, a 33-year-old woman in her 20th week of pregnancy, suffered cardiac arrest while at a church gathering. She was given CPR, defibrillated and transported to the emergency department. Three hours after arriving at the hospital, the patient's body was cooled to approximately 90 degrees Fahrenheit.  She was kept at a hypothermic temperature for 12 hours and then rewarmed to a normal temperature.  While the patient was being cooled, doctors monitored the fetus and detected fetal shivering, which stopped once the mother was re-warmed. 

The patient stayed in the hospital for 10 more days and was implanted with a cardioverter-defibrillator (ICD).  She resumed her work and normal activities of daily living for the remainder of her pregnancy and delivered a healthy baby boy at 39 weeks. 

Doctors evaluated the boy at 1, 2, 3, 6, 12 and 36 months of age and found he has reached all the normal development milestones.

"We would not normally treat a rare cardiac arrest pregnant patient with hypothermia because hypothermia was untested in this population and therefore considered too risky for the fetus," said Naseer Nasser M.D., the cardiologist who directed her care at Memorial Hospital in South Bend, Indiana. "However, without the recently proven benefit of hypothermia for cardiac arrest, mother and child would not have benefited from this lifesaving advance. This report suggests that with prudent clinical judgment, vigilance and a dedicated multi-disciplinary team, therapeutic hypothermia can be offered to pregnant women who survive cardiac arrest."

Michael Donnino, M.D., of Beth Israel Deaconess Medical Center in Boston, Mass, a co-author of the paper who is a member of the advanced cardiac life support subcommittee at the American Heart Association (AHA), said, "Publishing this case will add to the paucity of literature on the safety of hypothermia in pregnancy and provide support for the AHA's current recommendation of 'may consider use' of hypothermia in pregnancy."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine.

For more information: www.acep.org



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