As we learn more about what happens to the heart in arrest we encourage delivering more effective compressions with minimal interruption and administering an early effective shock to stop the heart and allow it to correct the 2 abnormal non-productive (no blood being pumped) rhythms. Ventricular Fibrillation (quivering) and Ventricular Tachycardia (beating too fast)] are the only two ineffective rhythms an AED will shock. Early use of an AED is an essential part of saving a victim, especially when you have two victims in one. In the case of a pregnant woman you have the mother and the baby who are facing extinction. The more effective you are in delivering firm compressions to the center of the mother’s chest also ensures that oxygen rich blood is being circulated to the baby in her womb too.
When you are administering CPR to a pregnant woman regardless of the stage of her pregnancy (1 to 9 months) you have to remember that two victims are crying out to be saved. When you press down directly on the center of the mother’s chest between the nipples with the heel of your hand you will see the cradle of the baby rise in response to your compression. This is normal and the baby who is housed in a fluid filled cocoon will not be negatively impacted by your pressing directly in the center of the mother’s chest.
In addition, the sooner you set up and use the AED the more chance the mother and baby have to survive. Remember the first step in using the AED is to turn it on and listen to the prompts. When the AED tells you to place the pads on the victim’s chest, do so.
When applying pads to a pregnant woman you place the pads exactly as indicated on the pads. If it becomes difficult for you, you can place one pad (right chest) on the front and the other (under the left nipple) on the back directly behind each other with both pads in a vertical position. If it is necessary to stop the pregnant woman’s heart and allow it to reset itself to the proper rhythm, either pad placement strategy will be effective. The baby in the womb will not be adversely affected by the shock passing through the Mother’s heart. The baby is insulated in its capsule away from the path of the shock.
The art of delivering effective high quality compressions becomes even more important to both victims’ survival. Today it is not unusual to expect that immediate high quality CPR and early defibrillation will save both the pregnant woman and her baby, and result in minimum in-hospital and post recovery rehabilitation after the event. This is especially beneficial to the baby whose birth is imminent.
The ECCU 2015 guidelines stress beginning CPR as soon as possible after recognition of cardiac arrest. If the pregnant woman is unconscious and does not respond to tapping on her shoulder, shout for help, and then check for breathing (erratic gasping breaths is not breathing) and a pulse (if you are trained) at the same time. If you don’t feel / see breathing and don’t feel a carotid pulse (if you are trained), shout for help. If the mother is not breathing start CPR immediately. If no one responds the second time you shout and you have a cell phone, call 911. Calling 911 is the most important thing you can do to ensure you get the help you need. If alone and no one responds and you know exactly where the AED is leave the victim and get it, or best case scenario someone responds, send that person to get the AED and call 911, while you start immediate high quality compressions. Remember, if alone, you can’t leave the victim alone for more than 4 minutes (that gives you 2 minutes to go and 2 minutes to come back). This is especially critical for mother and baby. Only leave the mother if you know exactly where the AED is and it is close by. The main focus should be on delivering effective compressions to a depth of at least 2 inches. Don’t be afraid to press on the mother’s chest. The new guidelines have also determined that a rate or speed of compressions should be more than 100 per minute and are even more beneficial if delivered at approximately 110 per minute. In my experience, most rescuers can consistently deliver effective compressions at approximately 108 – 110 compressions per minute. Going faster than that could affect the depth of compressions or chest recoil. Chest recoil is very important because it is the recoil that allows the ventricle to fill back up with blood and be ready for the next push. That means you place your shoulder directly over your hand with your arms straight (no bending) and push straight down and then bring your shoulders back up with the heel of your hand still on the chest to allow for effective chest recoil. Do Not allow your hands to leave the victim’s chest. It is very important to keep the heel of your hand directly in the center of the mother’s chest.
If you can have someone assist you in delivering compressions it will be even better for a positive outcome since keeping fresh hands on the chest will provide oxygen rich blood to the pregnant woman and her baby on a consistent basis.
Delivering High Quality CPR and working smoothly as a team decreases the amount of time between compression cycles, increases the chance of survival and Return Of Spontaneous Circulation (ROSC) by a factor of 300%. In other words, the chances of survival if all the steps are followed, are 3 times greater than it would have been previously. That is quite an improvement.
WORKING AS A TEAM TO DELIVER HIGH QUALITY CPR IS EVEN MORE IMPORTANT FOR MOTHER AND BABY
The only way to improve the outcome even better than working alone is to deliver high quality CPR as a team. There are several aspects to working as a team. Depending on the number of team members, one essential requirement is having someone to relieve the compressor every 2 minutes if possible (2 rescuers).
Another advantage is having someone to deliver breaths (3 rescuers) and finally if possible someone to operate the AED and coordinate the efforts of each rescuer (4 rescuers).
The coordinator provides constructive feedback to each rescuer according to their assigned task. The coordinator makes sure the compressions are deep enough and fast enough with proper chest recoil. They make sure the breaths are making the chest rise and are not being administered too fast or slowly. They also coordinate the continuation of compressions while the AED is charging and stop them before the shock is delivered, and assures that compressions are started immediately after the AED delivers the shock or pauses.
The coordinator makes sure all the steps are followed to the letter to insure the absolute best high quality CPR to the victim. Comprehensive Effective Team CPR assures the victim the greatest chance of survival.
If you follow the steps as indicated you will ensure the best chance of saving both the mother and the baby so they both can enjoy the birth of the baby together.