A retrospective cohort study investigating the rate of maternal characteristics associated with, and survival following, cardiac arrest during delivery hospitalisation, has found that older, non-Hispanic Black and low-income pregnant patients are disproportionately affected, but maintain better survival rates.
Published in the Annals of Internal Medicine, the paper by lead investigator Nicole Ford (Centers for Disease Control and Prevention, Atlanta, USA) and co-authors analysed US acute care hospitals from 2017–2019. Patient eligibility criteria included any delivery hospitalisation in women aged between 12–55 years recorded in the National Inpatient Sample (NIS) Database.
Utilising codes from the International Classification of Diseases, 10th Revision Clinical Modification, Ford et al identified delivery hospitalisations, cardiac arrest, underlying medical conditions, obstetric outcomes, and severe maternal complications. Additionally, they outlined that survival to hospital discharge was based on discharge disposition.
Among 10,921,784 US delivery hospitalisations, the investigators state the cardiac arrest rate was 13.4 per 100,000. Of the 1,465 patients—1 in 9,000—that experienced cardiac arrest, 68.6% (95% confidence interval (CI) 63.2–74%)—seven in 10—survived to hospital discharge.
The authors elucidate that cardiac arrest was more common among patients who were older, were non-Hispanic Black, had Medicare or Medicaid, or had underlying medical conditions. They further explain that acute respiratory distress syndrome was the most common co-occurring diagnosis (56.0% [95% CI, 50.2–61.7%]).
Ford and colleagues additionally identified mechanical ventilation (53.2% [95% CI, 47.5–59.0%]) as the most common co-occurring procedure or intervention examined. They note the incidence of survival to hospital discharge after cardiac arrest was lower with co-occurring disseminated intravascular coagulation (DIC) with or without transfusion (50.0% [95% CI, 35.8–64.2%] or 54.3% [95% CI, 39.2–69.5%]), respectively.
Concerning their study’s limitations, the researchers explain that cardiac arrests which occurred outside of the hospital were not included and that the temporalities of arrest, relative to the delivery or other maternal complications, is yet unknown. The authors state that their data “do not distinguish cause” the cardiac event, including pregnancy-related complications or other underlying causes in the pregnant women included within their study cohort.
