CodeBlue
Algorithms

Special Situations

Maternal Cardiac Arrest

Standard ACLS plus left uterine displacement, early airway, IV above the diaphragm, and resuscitative hysterotomy if no ROSC within minutes.

Open CPR timer
Interactive pathway
  1. Assess

    Initiate maternal cardiac arrest response

    • Activate maternal arrest team (obstetrics, anesthesia, neonatology)
    • Document time of onset
  2. Action

    BLS / ACLS

    • High-quality CPR; hands in the standard position on the sternum
    • Continuous manual left uterine displacement (LUD)
    • Defibrillation pads; shock if indicated: same energy as non-pregnant patients
  3. Medication

    Maternal interventions

    • Airway: expect difficult airway; most experienced provider; 100% O₂; avoid excessive ventilation
    • IV access above the diaphragm
    • If receiving IV magnesium: stop it and give calcium
    • Remove or detach fetal monitors
    Calcium chloride
    10 mL of 10% IV
    for magnesium toxicity
    Calcium gluconate
    30 mL of 10% IV
    alternative
  4. Decision

    Obvious gravid uterus?

    Uterus at or above the umbilicus (≈ ≥ 20 weeks) causes aortocaval compression.