Advanced resuscitation strategies for cardiac arrest in pregnancy: a systematic review

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2026年6月10日

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Takashi Hongo,
Tetsuya Yumoto,
Takafumi Obara,
Tomohiro Hiraoka,
Yoshinori Kosaki,
Shunta Jinno,
Ippei Matsuo,
Misa Sasanami,
Yuya Miyoshi,
Shodai Yoshihiro,
Takahiro Tsuge,
Atsunori Nakao,
Hiromichi Naito

摘要

Background

Cardiac arrest during pregnancy is a rare, life-threatening event. The roles of resuscitative delivery (RD) and extracorporeal cardiopulmonary resuscitation (ECPR) remain unclear. This systematic review summarizes maternal and neonatal outcomes according to initial resuscitation strategy.

Methods

This systematic review followed a preplanned protocol registered in the Open Science Framework and adhered to PRISMA guidelines. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi were searched from inception to May 8, 2025, without language restrictions. Cases were categorized by initial resuscitation strategy into four groups: RD–/ECPR–, RD+/ECPR–, RD–/ECPR+, and RD+/ECPR+.

Results

A total of 150 studies were included, comprising predominantly case reports and describing 268 pregnant patients with cardiac arrest and 274 neonates from 34 countries (2000–2025). Initial resuscitation strategies were RD–/ECPR– in 71/268 (26.5%), RD+/ECPR– in 184/268 (68.7%), RD–/ECPR + in 5/268 (1.9%), and RD+/ECPR + in 8/268 (3.0%). Favorable neurological outcomes were reported in 37/61 (61.9%), 39/146 (26.7%), 4/5 (80.0%), and 2/8 (25.0%), respectively, among cases with available data. Maternal survival beyond ICU admission (mid-term survival) was observed in 46/66 (69.7%), 69/171 (40.3%), 5/5 (100%), and 6/8 (75.0%), respectively. Neonatal survival beyond ICU admission was observed in 29/58 (50.0%), 61/101 (60.4%), 3/5 (60.0%), and 4/7 (57.1%). Among cases receiving both RD and ECPR, ECPR was initiated after RD in six cases and preceded RD in one case.

Conclusions

Maternal and neonatal outcomes after cardiac arrest during pregnancy varied widely across resuscitation strategies. The available evidence is limited by small, case-based reports, highlighting the need for large registries and multicenter studies to define the optimal use and sequencing of RD and ECPR.

Trial registration

A preplanned protocol for systematic review has been registered in the Open Science Framework (Osf.io) [https://osf.io/9xsrt/files/osfstorage].