Cherish the "heart of children" and care for the "heart of mothers" ——2023 Guidelines for the prevention, treatment and rescue of maternal cardiac arrest released

On the occasion of International Children's Day, we should care for children's heart health, starting from caring for the fetus' heart and caring for the "mother's heart" of pregnant women. Pregnant women are a group of people in a special period. Once a sudden cardiac arrest occurs, it will threaten the lives of both mother and child. Therefore, minimizing maternal mortality is an important guarantee to ensure the safety of mother and child throughout the perinatal period. The Chinese Maternal Cardiac Arrest Prevention, Treatment and Rescue Expert Committee, composed of the Chinese Society of Research Hospitals Cardiopulmonary Resuscitation Professional Committee, the Chinese Geriatric Health Association Cardiopulmonary Resuscitation Professional Committee, the Chinese Health Management Association Health Culture Committee, the Chinese Medical Association Science Popularization Branch, and the Beijing Medical Association Disaster Medicine and Cardiopulmonary Resuscitation Professional Committee, was written by professors Mi Yuhong, Zhou Feihu, Wang Lixiang, Li Yinping, Meng Qingyi, Zhang Jun, Zhang Xinyu and other professors. Based on the pathophysiology of cardiac arrest during pregnancy, the committee proposed high-risk factors for preventing and controlling cardiac arrest during pregnancy, cardiopulmonary resuscitation methods for treating cardiac arrest during pregnancy, and prevention and treatment standards for preventing cardiac arrest during pregnancy, reflecting the Chinese concept of cardiopulmonary resuscitation of preventing "potential heart" from above, treating "desire heart" in the middle, and saving "existing heart".

Cardiac arrest during pregnancy refers to cardiac arrest that occurs at any stage of pregnancy and within six weeks after the birth of the fetus. The factors that cause cardiac arrest during pregnancy are slightly different from those of ordinary adults. Knowing the high-risk factors that cause cardiac arrest during pregnancy is of great significance for the prevention and control of cardiac arrest in pregnant women. Common factors include causes during pregnancy or delivery [such as postpartum hemorrhage, antepartum hemorrhage, heart disease, amniotic fluid embolism (AFE) sepsis] and known or unknown diseases of the pregnant woman herself (such as cardiomyopathy, congenital heart disease, heart failure, valvular disease, connective tissue disease), etc. According to statistics, there are about 800 maternal deaths worldwide each year. From 2011 to 2013, the main cause of maternal death in the United States was cardiovascular factors, followed by non-cardiovascular factors, infection and bleeding. Similarly, from 2013 to 2015, the main cause of maternal death in the United Kingdom was also cardiovascular factors. The proportion of maternal deaths caused by anesthesia is gradually decreasing. Studies have shown that about 1% to 4% of pregnancies are complicated by maternal diseases. Currently, the prevalence and incidence of cardiac arrest during pregnancy and pregnancy-related heart disease are very limited worldwide. Studies from the United Kingdom show that sudden adult death syndrome, PPCM, aortic dissection (AD) and AMI are common causes of maternal death. Statistics from 10 Western countries show that the increase in the age of first pregnancy (about 28.8 to 31.2 years) is accompanied by an increase in the risk of cardiovascular disease during pregnancy. The occurrence of cardiac arrest in the late childbearing period (or 40 to 50 years old) is often associated with an increased incidence of cardiovascular risk factors. In particular, diabetes, hypertension and obesity. Hypertension during pregnancy (incidence 5% to 10%) has also become a common cause of cardiovascular dysfunction. Congenital heart disease is the most common cardiovascular disease during pregnancy in Western countries (75%-82%). Rheumatic valvular disease dominates in non-Western countries, accounting for 56% to 89% of all cardiovascular diseases during pregnancy. Cardiomyopathy is relatively rare, and its occurrence often represents a serious cardiovascular complication.

In 2022, the national maternal mortality rate was 15.7/100,000, the infant mortality rate dropped by 4.9‰, and the child mortality rate dropped to 6.8‰, all of which dropped to the lowest level in history. If the three-level prevention, prevention and rescue strategy is actively implemented and promoted during the "prenatal, intrapartum and postpartum" period of pregnant women, the first-level prevention is to prevent and control high-risk factors in normal times and prevent them as much as possible; the second-level prevention is to prevent and treat high-risk diseases in a timely manner, that is, to reduce their occurrence; the third-level prevention is to prevent and rescue high-risk types in emergencies, and minimize the maternal mortality rate. We strive to reduce my country's maternal mortality rate to below 12/100,000 by 2030, and the rate for children under 5 years old to 6‰. There is no doubt that the "Chinese Cardiopulmonary Resuscitation Expert Consensus" guidelines for the prevention, treatment and rescue of maternal cardiac arrest are a powerful guarantee for safeguarding the life and health rights of women and children.

(Mi Yuhong, Zhou Feihu, Wang Lixiang)