News: Cardiac arrest may be growing more common during labor and delivery, research shows

Cardiac arrest during labor and delivery appears more common in more recent years but with better survival rates, according to a national study recently published in the Annals of Internal Medicine. The findings showed this to be the case in particular for older, black, and low-income pregnant patients. Cardiac arrest occurred in about one in 9,000 women from 2017 to 2019, compared to a rate of one in 12,000 from 1998 to 2011. However, the overall survival rate improved over time, from 58.9% after cardiac arrest during hospital delivery in 1998 to 2011 to 68.6% in the 2017-2019 data, Medpage Today reported.

Among women admitted for delivery in the National Inpatient Sample (NIS) from 2017 to 2019, cardiac arrest occurred at a rate of 13.4 events per 100,000 delivery hospitalizations. The cardiac arrest rate stayed steady across the study period from 2017 to 2019. There was a change from ICD-9 to ICD-10 codes that might complicate comparisons with this and the earlier time period, but the researchers noted that a true increase was still plausible.

“[T]he higher rate of cardiac arrest may be related to the observed increased prevalence over time of characteristics associated with cardiac arrest, such as hypertensive disorders in pregnancy, heart disease, and hemorrhage,” they said.

Compared to patients hospitalized without cardiac arrest, cardiac arrest rates during delivery hospitalization were higher for the following groups:

• Older maternal age (median 31.1 vs 28.4 years)
• Black patients (28.6% vs 15.1%)
• Medicare or Medicaid beneficiaries (53.1% vs 43.2%)
• Chronic hypertension (13.7% vs 2.8%)
• Mental health disorders (18.1% vs 7.8%)
• Substance use disorder (9.2% vs 2.7%)
• Acquired heart disease (6.1% vs 0.2%)

The researchers recommended health care organizations implement strategies on maternal cardiac arrest to better reduce disparities in outcomes, addressing upstream factors associated with cardiac arrest incidence and management. More information is needed on what the specific drivers of maternal cardiac arrest are during delivery, however.

“Implementing clinical guidelines, ensuring that pregnant people receive risk-appropriate care, and addressing potential knowledge deficits in maternal cardiac arrest and cardiopulmonary resuscitation technique for pregnant people may improve maternal outcomes,” they said.

Editor’s note: To read Medpage Today’s coverage of this story, click here. To access the full study, click here.