Authors: Furdyna M et al.
Anesthesiology 144(4):796–810, April 2026
Summary:
This large multicenter retrospective cohort study provides one of the most comprehensive evaluations of maternal cardiac arrest during peripartum anesthetic care in the United States. Using data from over 778,000 deliveries across 60 institutions, the authors identified 87 cases of maternal cardiac arrest, corresponding to an incidence of approximately 11.2 per 100,000 deliveries (roughly 1 in 9,000).
The most common causes of cardiac arrest were obstetric in nature, with hemorrhage accounting for 40% and amniotic fluid embolism for 31% of cases. Anesthesia-related causes represented a smaller but important proportion (11.5%), with high neuraxial blockade identified as the leading anesthetic contributor. The majority of arrests occurred during cesarean delivery, highlighting this as a particularly high-risk setting.
Outcomes were better than historically reported, with return of spontaneous circulation achieved in 77% of patients and 68% surviving to 30 days. However, the study also identified significant patient-level risk factors, including advanced maternal age (≥40), morbid obesity (BMI ≥40), and certain racial groups. High-risk clinical conditions such as pulmonary hypertension, placenta accreta spectrum, ischemic heart disease, and stillbirth were strongly associated with increased risk.
Importantly, nearly 20% of cases demonstrated deviations from established cardiac arrest management guidelines, suggesting opportunities for improvement in recognition, response, and adherence to protocols. The study also highlights the complexity of managing these events, where rapid multidisciplinary coordination is essential.
Overall, this study reinforces that while maternal cardiac arrest is rare, it is often predictable, frequently related to known obstetric complications, and in some cases preventable through improved systems, preparedness, and adherence to best practices.
Key Points:
- Maternal cardiac arrest occurs in approximately 1 in 9,000 deliveries
- Hemorrhage and amniotic fluid embolism are the leading causes
- Anesthesia-related causes account for ~11.5%, with high neuraxial block most common
- Most arrests occur during cesarean delivery
- Survival to 30 days is approximately 68%
- Deviations from resuscitation guidelines occur in nearly 20% of cases
What You Should Know:
This isn’t just a rare event—it’s a predictable one. Most cases come from hemorrhage or embolism, and a meaningful number involve anesthesia decisions. The bigger issue is systems: recognition, response, and protocol adherence. If 20% aren’t following guidelines, that’s where improvement—and lives saved—will come from.
We would like to thank Anesthesiology for allowing us to summarize and share this article.