KKH assigns dedicated response code for maternal cardiac arrest

SINGAPORE — When a heavily-pregnant woman suffers a cardiac arrest in KK Women’s and Children’s Hospital (KKH) and is not responding to cardiopulmonary resuscitation, a “Code Red” message sounds through the public announcement system, activating a team trained in performing resuscitation on pregnant women.

Assigning a dedicated response code for such emergencies is a first in hospitals here.

Although maternal cardiac arrest is very rare — no statistics are available on incidences here — resuscitation is more challenging due to anatomical and physiological changes during pregnancy, noted Dr Deepak Mathur, who led the implementation of the code last month.

“The window of opportunity for medical intervention is really just a few minutes,” said the consultant in the women’s anaesthesia department.

Prompt and effective intervention can also enhance the survival of both mother and child, the doctor added.

Resuscitation for cardiac arrests during pregnancy are complicated because the weight of the growing baby in an enlarged womb presses on the mother’s large blood vessels, affecting the heart’s ability to supply oxygen to vital organs.

Code Red is activated for mothers carrying babies past the 20-week gestation mark, and medical response personnel involve those in obstetrics, gynaecology, women’s anaesthesia and neonatology, as well as a midwife.

This is because, at times, the medical response for such cases could involve a Caesarean section while cardiopulmonary resuscitation is being performed — called a perimortem Caesarean section — to improve the mother’s chances of responding to resuscitation efforts, said Dr Mathur.

This kind of Caesarean section is best performed within five minutes of the onset of the cardiac arrest, to prevent brain damage in the mother and newborn, caused by oxygen deprivation.

Dr Mathur said that, in the past two years, KKH has encountered three patients with maternal cardiac arrest — some medical studies say the incidence is about 1 in 30,000. Two of them responded successfully to prompt resuscitation involving a perimortem Caesarean section.

“We were encouraged by these outcomes and hence, have introduced a dedicated code to enable prompt and effective resuscitation and intervention to enhance the survival of both the mother and baby, and to optimise long-term outcomes,” said Dr Mathur.

Rigorous simulation training and drills are regularly conducted for the medical personnel from various disciplines involved, he added.

Meanwhile, in other hospitals here, there are also emergency response codes assigned for other conditions.

Khoo Teck Puat Hospital, for instance, has three assigned codes for emergencies: Code Blue for the resuscitation of patients suffering cardiac arrest within the hospital ward, Code A&E for resuscitation of patients in cardiac arrest in the non-clinical areas in the hospital, and Code CE for civil emergencies and disasters.

Likewise, the National University Hospital has codes separating resuscitation response for adults and children who suffer a cardiac arrest, or are in respiratory distress. There is also a code for emergency Caesarean section.