This handout is for post-cardiac-arrest care — peripartum maternal arrest. Your care team identified this based on: rosc after maternal cardiac arrest in pregnant patient (typically ≥20 wks ga) or within 48-72h post-partum (aha 2024 maternal arrest).
Other reasons your team may use this plan: sudden cv collapse during labor / cesarean / immediate post-partum — afe differential top of list (hui 2022 consensus); comatose pregnant patient post-rosc — ttm candidate; pregnancy not a contraindication (ttm2; aha 2024).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| norepinephrine | 0.05-0.5 µg/kg/min titrate MAP ≥65 (≥70-75 if undelivered for uteroplacental flow) | IV | continuous | SOAP-II PMID 20200382; first-line in pregnancy per AHA 2024 maternal arrest (no vasopressor contraindicated in pregnancy when arrest) |
| amiodarone | 300 mg IV bolus → 150 mg if recurrent → 1 mg/min × 6h → 0.5 mg/min × 18h | IV | continuous taper | AHA 2020 ACLS Class IIb; pregnancy concern (fetal thyroid) but life-saving so used per AHA 2024 maternal arrest |
| magnesium sulfate | 1-2 g IV bolus + 1-2 g/h infusion (eclampsia loading 4-6 g IV bolus then 1-2 g/h) | IV | bolus + continuous | AHA 2020 ACLS Class IIa for TdP; ACOG-WHO Class I for eclampsia seizure prophylaxis (Magpie PMID 12057549) |
| tranexamic acid | 1 g IV over 10 min within 3h of bleeding onset; repeat 1g if bleeding continues | IV | one-time + repeat | WOMAN trial PMID 28456510 — TXA reduces death from PPH if given <3h; CRASH-2 PMID 20554319 |
| oxytocin | 10 U IM + 10-40 U in 1L NS infusion | IV/IM | continuous post-delivery | ACOG Class I uterotonic first-line for atony PPH |
| propofol | 5-50 µg/kg/min | IV | continuous; titrate RASS | PADIS 2018; pregnancy category B; propofol crosses placenta but standard ICU sedation post-delivery |
| warfarin | AVOID during pregnancy (teratogenic 6-12 wks; fetal hemorrhage); switch to LMWH if AC needed | PO | AVOID | ACOG + AHA 2024 — warfarin teratogenic and fetal bleeding risk; LMWH preferred during pregnancy |
| enoxaparin | 1 mg/kg SC BID (treatment); 40 mg SC daily (prophylaxis) | SC | BID/daily | ACOG / RCOG / CHEST 2018 — LMWH first-line AC during pregnancy + breastfeeding |
Plan: Peripartum maternal post-arrest phenotype — modified ACLS pharmacotherapy + obstetric resuscitation + AFE/PPCM/PE/hemorrhage etiology bundles (AHA 2024 maternal arrest + Hui 2022 AFE consensus)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiology follow-up at 1-2 weeks for PPCM EF surveillance; MFM follow-up for any pregnancy continuation; counseling re: future pregnancy risk (PPCM with EF <30 — strong recommendation against future pregnancy); contraception planning; mental health (postpartum + post-arrest PTSD risk very high); AVID-style ICD pathway only for definite cardiac arrhythmic etiology unrelated to reversible peripartum cause
Guideline: AHA 2024 maternal cardiac arrest scientific statement + AHA 2020 ACLS / Post-Cardiac-Arrest Care + Hui 2022 AFE international consensus + ACOG hemorrhage / hypertension bundles