How should CPR be adjusted for a pregnant patient in cardiac arrest?

How should CPR be adjusted for a pregnant patient in cardiac arrest?

• A. Use left-lateral tilt to relieve aortocaval compression; perform standard CPR with defibrillation as indicated
• B. Place patient in full Trendelenburg position
• C. Avoid defibrillation to protect the fetus
• D. Perform chest compressions only without ventilation

Answer: (A)

Relieving aortocaval compression is the key adjustment during CPR in pregnancy. Placing the patient with a left-lateral tilt (about 15–30 degrees) or manually displacing the uterus to the left helps relieve pressure from the inferior vena cava and aorta, improving venous return to the heart and making chest compressions more effective. Once the uterus is relieved of that pressure, continue standard CPR and deliver defibrillation as indicated by the rhythm. This approach keeps the mother’s circulation supported, which is what ultimately benefits both mother and fetus. Full Trendelenburg is not used because tilting the patient that far toward the head can worsen respiratory mechanics, hinder ventilation, and doesn’t relieve aortocaval compression effectively. Defibrillation should not be avoided to protect the fetus; maternal life support takes precedence, and defibrillation is performed exactly as in nonpregnant adults when indicated. Chest compressions without ventilation is also not appropriate; high-quality CPR includes ventilations unless an advanced airway is in place, ensuring adequate oxygen delivery to both mother and fetus.

Relieving aortocaval compression is the key adjustment during CPR in pregnancy. Placing the patient with a left-lateral tilt (about 15–30 degrees) or manually displacing the uterus to the left helps relieve pressure from the inferior vena cava and aorta, improving venous return to the heart and making chest compressions more effective. Once the uterus is relieved of that pressure, continue standard CPR and deliver defibrillation as indicated by the rhythm. This approach keeps the mother’s circulation supported, which is what ultimately benefits both mother and fetus.

Full Trendelenburg is not used because tilting the patient that far toward the head can worsen respiratory mechanics, hinder ventilation, and doesn’t relieve aortocaval compression effectively. Defibrillation should not be avoided to protect the fetus; maternal life support takes precedence, and defibrillation is performed exactly as in nonpregnant adults when indicated. Chest compressions without ventilation is also not appropriate; high-quality CPR includes ventilations unless an advanced airway is in place, ensuring adequate oxygen delivery to both mother and fetus.