Cardiac arrest during pregnancy is a dedicated chapter in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; however, a robust maternal cardiac arrest knowledge translation strategy and emergency response plan is not usually the focus of institutional emergency preparedness programs. Although maternal cardiac arrest is rare, the emergency department is a high-risk area for receiving pregnant women in either prearrest or full cardiac arrest. It is imperative that institutions review and update emergency response plans for a maternal arrest. This review highlights the most recent science, guidelines, and recommended implementation strategies related to a maternal arrest. The aim of this paper is to increase the understanding of the important physiological differences of, and management strategies for, a maternal cardiac arrest, as well as provide institutions with the most up-to-date literature on which they can build emergency preparedness programs for a maternal arrest. 1. Introduction Managing a maternal cardiac arrest is an extremely challenging and trying task for emergency department (ED) staff as there are two patients, the mother and the fetus. Since out-of-hospital maternal cardiac arrests carry the worst outcomes, emergency medical services (EMS) also play an integral part in the management process [1]. The optimal management of a maternal cardiac arrest requires the participation of several different nonemergency teams, as well as the use of specialized equipment [2, 3], neither of which are part of the usual emergency department code protocols. This would include the obstetrical team, the anesthesia team, and the neonatal team, as well as equipment for a perimortem cesarean section and neonatal resuscitation. Ensuring that the right staff and equipment arrive at the code scene in a timely manner is imperative but often practically difficult. Education and training are essential to managing a maternal cardiac arrest; however, the current skill, knowledge, and implementation of existing guidelines among staff are poor [4–6]. Current ACLS training courses do not routinely include a comprehensive review of maternal resuscitation, and while specialized courses are being developed, they are not yet widely available [7]. Cardiac disease is the number one cause of maternal mortality based on a United Kingdom database that holds the largest population-based data on this specific group [8]. Women are deferring pregnancy to older ages, and more women with complex health problems are choosing to
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