What is the appropriate management for a cardiac arrest in a pregnant patient at 26 weeks’ gestation?

In the event of a cardiac arrest in a pregnant patient, particularly one who is 26 weeks along in her pregnancy, the most appropriate management is to perform a resuscitative cesarean delivery within 5 minutes. This prompt action is critical because in later stages of pregnancy, the enlarged uterus can compress the inferior vena cava when the patient is in a supine position, potentially leading to impaired venous return and further complicating resuscitation efforts.

Delivering the fetus promptly can relieve this compression and greatly improve perfusion to the mother and thus her chances of survival. Additionally, fetal viability increases significantly if delivered before the 30-minute mark of a cardiac arrest. The focus on rapid intervention reflects current guidelines that recommend that resuscitative measures should prioritize both maternal and fetal outcomes, with an emphasis on timely delivery to address the unique physiological challenges presented by pregnancy.

Continuing CPR for an extended period before considering cesarean delivery may not be effective given the significant risks involved, and administering epinephrine prior to delivery is typically not recommended in this scenario, as the focus should be on achieving rapid delivery. Prioritizing maternal resuscitation over fetal delivery could be detrimental due to the reasons stated above; addressing both health issues simultaneously can improve