Targeted Temperature Management in Pregnant Patients after Cardiac Arrest: A Systematic Review

Azadikhah Jahromi, Sina; Ostovan, Mina; Zahedi, Razieh; Rahmanian, Zhila; Abdollahzadeh, Pegah

doi:10.30476/ijms.2024.104167.3767

Articles InPress

Document Type : Review Article

Authors

Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran

10.30476/ijms.2024.104167.3767

Abstract

Background: Targeted temperature management (TTM) is a standard care intervention following resuscitation, known to improve neurological outcomes in patients. However, there is a lack of comprehensive studies on the application of TTM, specifically therapeutic hypothermia, in pregnant patients. Considering the critical importance of maternal and fetal health, this study aimed to investigate the use of TTM in pregnant women following cardiac arrest.
Methods: This systematic review was conducted by searching multiple databases, including Web of Science, PubMed Central, MEDLINE, Scopus, EMBASE, and Cochrane, up to October 2024. The search was conducted with no restrictions on time, place, or language. Articles were selected based on predefined inclusion criteria, which included case reports detailing the use of TTM in pregnant women after cardiac arrest. The quality of the included studies was assessed using the Jonna Briggs Institute (JBI) checklist for case reports.
Results: A total of nine articles met the inclusion criteria. Among the reported cases, there was 1 (11.1%) case of maternal death and 2 (22.2%) cases of fetal death, neither of which appeared to be directly attributable to the use of hypothermia. Neurological outcomes were favorable for all surviving mothers and fetuses following the application of TTM. The most common maternal complications during hypothermia for mothers were decreased blood pressure and heart rate, occurring in 2 (22.2%) cases. For the fetuses, bradycardia was the most frequently reported complication, occurring in 5 (55.5%) cases.
Conclusion: The use of TTM in pregnant patients following cardiac arrest might be considered on a case-by-case basis with the involvement of a multidisciplinary team. Pregnancy does not appear to be an absolute contraindication for TTM. However, close fetal monitoring is essential to ensure fetal well-being during the procedure.

Highlights

Sina Azadikhah Jahromi (Google Scholar)

Mina Ostovan (Google Scholar)

Keywords

References

1. Beck B, Bray J, Cameron P, Smith K, Walker T, Grantham H, et al. Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: Results from the Aus-ROC Epistry. Resuscitation. 2018;126:49-57. doi: 10.1016/j.resuscitation.2018.02.029. PubMed PMID: 29499230.
2. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81:1479-87. doi: 10.1016/j.resuscitation.2010.08.006. PubMed PMID: 20828914.
3. Wong CX, Brown A, Lau DH, Chugh SS, Albert CM, Kalman JM, et al. Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives. Heart Lung Circ. 2019;28:6-14. doi: 10.1016/j.hlc.2018.08.026. PubMed PMID: 30482683.
4. Nolan JP, Sandroni C, Bottiger BW, Cariou A, Cronberg T, Friberg H, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021;47:369-421. doi: 10.1007/s00134-021-06368-4. PubMed PMID: 33765189; PubMed Central PMCID: PMCPMC7993077.
5. Grasner JT, Lefering R, Koster RW, Masterson S, Bottiger BW, Herlitz J, et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016;105:188-95. doi: 10.1016/j.resuscitation.2016.06.004. PubMed PMID: 27321577.
6. Lusebrink E, Binzenhofer L, Kellnar A, Scherer C, Schier J, Kleeberger J, et al. Targeted Temperature Management in Postresuscitation Care After Incorporating Results of the TTM2 Trial. J Am Heart Assoc. 2022;11:e026539. doi: 10.1161/JAHA.122.026539. PubMed PMID: 36285786; PubMed Central PMCID: PMCPMC9673653.
7. Panchal AR, Bartos JA, Cabanas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142:S366-S468. doi: 10.1161/CIR.0000000000000916. PubMed PMID: 33081529.
8. Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. 2015;132:1747-73. doi: 10.1161/CIR.0000000000000300. PubMed PMID: 26443610.
9. Mhyre JM, Tsen LC, Einav S, Kuklina EV, Leffert LR, Bateman BT. Cardiac arrest during hospitalization for delivery in the United States, 1998-2011. Anesthesiology. 2014;120:810-8. doi: 10.1097/ALN.0000000000000159. PubMed PMID: 24694844; PubMed Central PMCID: PMCPMC4445354.
10. Khalil A, Samara A, O’Brien P, Coutinho CM, Quintana SM, Ladhani SN. A call to action: the global failure to effectively tackle maternal mortality rates. Lancet Glob Health. 2023;11:e1165-e7. doi: 10.1016/S2214-109X(23)00247-4. PubMed PMID: 37474218.
11. Declercq E, Thoma M. Measuring US Maternal Mortality. JAMA. 2023;330:1731-2. doi: 10.1001/jama.2023.19945. PubMed PMID: 37831458.
12. Nordberg P, Taccone FS, Truhlar A, Forsberg S, Hollenberg J, Jonsson M, et al. Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest: The PRINCESS Randomized Clinical Trial. JAMA. 2019;321:1677-85. doi: 10.1001/jama.2019.4149. PubMed PMID: 31063573; PubMed Central PMCID: PMCPMC6506882
13. Deye N, Cariou A, Girardie P, Pichon N, Megarbane B, Midez P, et al. Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study. Circulation. 2015;132:182-93. doi: 10.1161/CIRCULATIONAHA.114.012805. PubMed PMID: 26092673.
14. Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullen S, et al. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2021;384:2283-94. doi: 10.1056/NEJMoa2100591. PubMed PMID: 34133859.
15. Debaty G, Maignan M, Savary D, Koch FX, Ruckly S, Durand M, et al. Impact of intra-arrest therapeutic hypothermia in outcomes of prehospital cardiac arrest: a randomized controlled trial. Intensive Care Med. 2014;40:1832-42. doi: 10.1007/s00134-014-3519-x. PubMed PMID: 25348858.
16. Bernard SA, Smith K, Cameron P, Masci K, Taylor DM, Cooper DJ, et al. Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. Circulation. 2010;122:737-42. doi: 10.1161/CIRCULATIONAHA.109.906859. PubMed PMID: 20679551.
17. Bernard SA, Smith K, Finn J, Hein C, Grantham H, Bray JE, et al. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline: The RINSE Trial (Rapid Infusion of Cold Normal Saline). Circulation. 2016;134:797-805. doi: 10.1161/CIRCULATIONAHA.116.021989. PubMed PMID: 27562972.
18. Lopez-de-Sa E, Juarez M, Armada E, Sanchez-Salado JC, Sanchez PL, Loma-Osorio P, et al. A multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial. Intensive Care Med. 2018;44:1807-15. doi: 10.1007/s00134-018-5256-z. PubMed PMID: 30343315.
19. Scales DC, Cheskes S, Verbeek PR, Pinto R, Austin D, Brooks SC, et al. Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial. Resuscitation. 2017;121:187-94. doi: 10.1016/j.resuscitation.2017.10.002. PubMed PMID: 28988962.
20. Look X, Li H, Ng M, Lim ETS, Pothiawala S, Tan KBK, et al. Randomized controlled trial of internal and external targeted temperature management methods in post- cardiac arrest patients. Am J Emerg Med. 2018;36:66-72. doi: 10.1016/j.ajem.2017.07.017. PubMed PMID: 28698133.
21. Lascarrou JB, Merdji H, Le Gouge A, Colin G, Grillet G, Girardie P, et al. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. N Engl J Med. 2019;381:2327-37. doi: 10.1056/NEJMoa1906661. PubMed PMID: 31577396.
22. Pang PY, Wee GH, Hoo AE, Sheriff IM, Lim SL, Tan TE, et al. Therapeutic hypothermia in adult patients receiving extracorporeal life support: early results of a randomized controlled study. J Cardiothorac Surg. 2016;11:43. doi: 10.1186/s13019-016-0437-8. PubMed PMID: 27044507; PubMed Central PMCID: PMCPMC4820957.
23. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557-63. doi: 10.1056/NEJMoa003289. PubMed PMID: 11856794.
24. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906. doi: 10.1016/j.ijsu.2021.105906. PubMed PMID: 33789826.
25. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetc R, et al. Chapter 7: Systematic Reviews of Etiology and Risk. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. 2020. p. 220-72.
26. Chauhan A, Musunuru H, Donnino M, McCurdy MT, Chauhan V, Walsh M. The use of therapeutic hypothermia after cardiac arrest in a pregnant patient. Ann Emerg Med. 2012;60:786-9. doi: 10.1016/j.annemergmed.2012.06.004. PubMed PMID: 22762909.
27. Conrad SK, Lutins E, Lanni S, Karjane N. Targeted temperature management following third trimester cardiac arrest. J Clin Images Med Case Rep. 2021;2:1186. doi: 10.52768/2766-7820/1186.
28. De Santis V, Negri M, Nencini C, Fusari M. Successful use of targeted temperature management in pregnancy after out-of-hospital cardiac arrest. Am J Emerg Med. 2016;34:122. doi: 10.1016/j.ajem.2015.05.049. PubMed PMID: 26123929.
29. Hogg JP, Temming LA, Pollack R. Therapeutic hypothermia and cardiac intervention after cardiac arrest in pregnancy with underlying maternal arrhythmia: A case report. Case Rep Womens Health. 2020;28:e00259. doi: 10.1016/j.crwh.2020.e00259. PubMed PMID: 33088724; PubMed Central PMCID: PMCPMC7559256.
30. McMillan TE, Austin S, Hyrkas K. Case Report of Cardiopulmonary Arrest During Pregnancy due to Opioid Overdose. J Obstet Gynecol Neonatal Nurs. 2021;50:205-13. doi: 10.1016/j.jogn.2020.11.003. PubMed PMID: 33482106.
31. Oami T, Oshima T, Oku R, Nakanishi K. Successful treatment of pulmonary embolism-induced cardiac arrest by thrombolysis and targeted temperature management during pregnancy. Acute Med Surg. 2018;5:292-5. doi: 10.1002/ams2.345. PubMed PMID: 29988697; PubMed Central PMCID: PMCPMC6028790.
32. Oguayo KN, Oyetayo OO, Stewart D, Costa SM, Jones RO. Successful Use of Therapeutic Hypothermia in a Pregnant Patient. Tex Heart Inst J. 2015;42:367-71. doi: 10.14503/THIJ-14-4331. PubMed PMID: 26413021; PubMed Central PMCID: PMCPMC4567107.
33. Rittenberger JC, Kelly E, Jang D, Greer K, Heffner A. Successful outcome utilizing hypothermia after cardiac arrest in pregnancy: a case report. Crit Care Med. 2008;36:1354-6. doi: 10.1097/CCM.0b013e318169ee99. PubMed PMID: 18379264.
34. Wible EF, Kass JS, Lopez GA. A report of fetal demise during therapeutic hypothermia after cardiac arrest. Neurocrit Care. 2010;13:239-42. doi: 10.1007/s12028-010-9395-5. PubMed PMID: 20559755.
35. Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, et al. Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S768-86. doi: 10.1161/CIRCULATIONAHA.110.971002. PubMed PMID: 20956225.
36. Reynolds EC, Zenasni Z, Harrison DA, Rowan KM, Nolan JP, Soar J, et al. How do information sources influence the reported Cerebral Performance Category (CPC) for in-hospital cardiac arrest survivors? An observational study from the UK National Cardiac Arrest Audit (NCAA). Resuscitation. 2019;141:19-23. doi: 10.1016/j.resuscitation.2019.05.035. PubMed PMID: 31199943.
37. Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Koos BJ, et al. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2017;135:e50-e87. doi: 10.1161/CIR.0000000000000458. PubMed PMID: 28082385.
38. Ryu C, Choi GJ, Park YH, Kang H. Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia: A Systematic review and network meta-analysis protocol. Medicine (Baltimore). 2019;98:e13947. doi: 10.1097/MD.0000000000013947. PubMed PMID: 30608428; PubMed Central PMCID: PMCPMC6344174.
39. Mattingly JE, D’Alessio J, Ramanathan J. Effects of obstetric analgesics and anesthetics on the neonate : a review. Paediatr Drugs. 2003;5:615-27. doi: 10.2165/00148581-200305090-00004. PubMed PMID: 12956618.
40. Albrecht M, Dulfer K, Hunfeld M, de Jonge RCJ, Buysse CMP. What Is the True Meaning of a “Good” Pediatric Cerebral Performance Category Score at Hospital Discharge in Pediatric Cardiac Arrest Survivors? Crit Care Med. 2023;51:e134-e5. doi: 10.1097/CCM.0000000000005857. PubMed PMID: 37199558.
41. Beckett VA, Knight M, Sharpe P. The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG. 2017;124:1374-81. doi: 10.1111/1471-0528.14521. PubMed PMID: 28233414.
42. Campbell TA, Sanson TG. Cardiac arrest and pregnancy. J Emerg Trauma Shock. 2009;2:34-42. doi: 10.4103/0974-2700.43586. PubMed PMID: 19561954; PubMed Central PMCID: PMCPMC2700584.
43. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005;353:1574-84. doi: 10.1056/NEJMcps050929. PubMed PMID: 16221780.
44. Aboud E, Neales K. The effect of maternal hypothermia on the fetal heart rate. Int J Gynaecol Obstet. 1999;66:163-4. doi: 10.1016/s0020-7292(99)00058-2. PubMed PMID: 10468340.
45. Buffolo E, Palma JH, Gomes WJ, Vega H, Born D, Moron AF, et al. Successful use of deep hypothermic circulatory arrest in pregnancy. Ann Thorac Surg. 1994;58:1532-4. doi: 10.1016/0003-4975(94)91952-6. PubMed PMID: 7979691.
46. Cardosi RJ, Chez RA. Magnesium sulfate, maternal hypothermia, and fetal bradycardia with loss of heart rate variability. Obstet Gynecol. 1998;92:691-3. doi: 10.1016/s0029-7844(98)00212-9. PubMed PMID: 9764667.
47. Golden LP. Aortic valve repair and arch replacement during pregnancy: a case report. AANA J. 1996;64:243-54. PubMed PMID: 9095696.
48. Hankins GD, Leicht T, Van Hook JW. Prolonged fetal bradycardia secondary to maternal hypothermia in response to urosepsis. Am J Perinatol. 1997;14:217-9. doi: 10.1055/s-2007-994130. PubMed PMID: 9259931.
49. Jadhon ME, Main EK. Fetal bradycardia associated with maternal hypothermia. Obstet Gynecol. 1988;72:496-7. PubMed PMID: 3043300.
50. John AS, Gurley F, Schaff HV, Warnes CA, Phillips SD, Arendt KW, et al. Cardiopulmonary bypass during pregnancy. Ann Thorac Surg. 2011;91:1191-6. doi: 10.1016/j.athoracsur.2010.11.037. PubMed PMID: 21440145.
51. Pomini F, Mercogliano D, Cavalletti C, Caruso A, Pomini P. Cardiopulmonary bypass in pregnancy. Ann Thorac Surg. 1996;61:259-68. doi: 10.1016/0003-4975(95)00818-7. PubMed PMID: 8561577.
52. Rodis JF, Vintzileos AM, Campbell WA, Deaton JL, Nochimson DJ. Maternal hypothermia: an unusual complication of magnesium sulfate therapy. Am J Obstet Gynecol. 1987;156:435-6. doi: 10.1016/0002-9378(87)90300-0. PubMed PMID: 3826181.
53. Sakaguchi M, Kitahara H, Seto T, Furusawa T, Fukui D, Yanagiya N, et al. Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome. Eur J Cardiothorac Surg. 2005;28:280-3. doi: 10.1016/j.ejcts.2005.02.047. PubMed PMID: 15939618.
54. Baker S, Lam C, Lubbers W, Clark K, Eghtesady P. Dobutamine is the optimal inotrope for the fetus. American Journal of Obstetrics and Gynecology. 2006;195:S196. doi: 10.1016/j.ajog.2006.10.704.
55. Batra AS, Balaji S. Fetal arrhythmias: Diagnosis and management. Indian Pacing Electrophysiol J. 2019;19:104-9. doi: 10.1016/j.ipej.2019.02.007. PubMed PMID: 30817991; PubMed Central PMCID: PMCPMC6531664.
56. Shankaran S. Neonatal encephalopathy: treatment with hypothermia. J Neurotrauma. 2009;26:437-43. doi: 10.1089/neu.2008.0678. PubMed PMID: 19281415; PubMed Central PMCID: PMCPMC2828322.
57. Chervenak FA, McCullough LB. Ethics in obstetrics and gynecology. An overview. Eur J Obstet Gynecol Reprod Biol. 1997;75:91-4. doi: 10.1016/s0301-2115(97)00192-9. PubMed PMID: 9447354.
58. Kikuchi J, Deering S. Cardiac arrest in pregnancy. Semin Perinatol. 2018;42:33-8. doi: 10.1053/j.semperi.2017.11.007. PubMed PMID: 29246735.

Iranian Journal of Medical Sciences

Targeted Temperature Management in Pregnant Patients after Cardiac Arrest: A Systematic Review

References

References

Articles InPress, Corrected Proof
Available Online from 25 May 2025

Targeted Temperature Management in Pregnant Patients after Cardiac Arrest: A Systematic Review

References

References

Articles InPress, Corrected Proof Available Online from 25 May 2025

Articles InPress, Corrected Proof
Available Online from 25 May 2025