Authors: Furdyna MJ et al.
Journal: Anesthesiology, Accepted December 23, 2025. DOI: 10.1097/ALN.0000000000005905
Summary
This large multicenter retrospective cohort study evaluated the frequency, causes, management, and outcomes of maternal peripartum cardiac arrest occurring during peri-anesthetic care in the United States. Using the Multicenter Perioperative Outcomes Group database, the investigators analyzed more than 778,000 deliveries across 60 institutions between 2015 and 2022, with rigorous manual chart review to confirm true cardiac arrest events and characterize their clinical context.
Maternal cardiac arrest occurred at a rate of 11.2 per 100,000 deliveries, confirming that while rare, these events remain clinically significant. The majority of arrests occurred during cesarean delivery and were most commonly attributed to obstetric causes rather than anesthetic complications. Hemorrhage was the leading etiology, followed closely by amniotic fluid embolism. Anesthetic-related causes, such as high spinal anesthesia, accounted for a smaller but still meaningful proportion of events.
Return of spontaneous circulation was achieved in over three-quarters of patients, and approximately two-thirds survived to 30 days. Survivors had relatively short hospital stays, suggesting that prompt recognition and management can lead to favorable outcomes even after catastrophic events. However, deviations from established cardiac arrest guidelines were identified in nearly one-fifth of cases, highlighting important opportunities for system-level improvement.
The study also identified several demographic and clinical risk factors associated with maternal cardiac arrest, including advanced maternal age, severe obesity, Black race, Asian or Pacific Islander race, pulmonary hypertension, placenta accreta spectrum, ischemic heart disease, and stillbirth. These findings underscore the importance of anticipatory planning, multidisciplinary coordination, and adherence to resuscitation guidelines in high-risk obstetric patients.
Key Points
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Maternal peripartum cardiac arrest occurred at a rate of 11.2 per 100,000 deliveries in this large US cohort.
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Most arrests occurred during cesarean delivery and were driven by obstetric causes rather than anesthesia.
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Hemorrhage and amniotic fluid embolism accounted for over 70% of cardiac arrest etiologies.
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Anesthetic complications were responsible for approximately 11% of events.
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Return of spontaneous circulation was achieved in 77%, with nearly 68% surviving to 30 days.
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Deviations from cardiac arrest guidelines occurred in almost one in five cases.
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Findings support focused efforts on hemorrhage preparedness, guideline adherence, and risk stratification.
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