Maternal cardiac arrest (MCA) during the peripartum period remains one of the most critical emergencies in obstetric medicine. A newly published multicenter cohort study in Anesthesiology (2026) provides one of the most comprehensive analyses to date, offering detailed insights into incidence, etiology, risk factors, and management during anesthetic care.

Overview of the study

This large retrospective cohort study analyzed 778,102 deliveries across 60 U.S. institutions between 2015 and 2022. The investigation focused specifically on cardiac arrest occurring during or within 7 days of anesthetic care.

Key findings

• Incidence:
  • 11.2 per 100,000 deliveries (~1 in 9,000)
• Total cases identified:
  • 87 confirmed maternal cardiac arrests
• Survival outcomes:
  • Return of spontaneous circulation (ROSC): 77%
  • 30-day survival: 67.8%
• Primary causes:
  • Hemorrhage: 40.2%
  • Amniotic fluid embolism (AFE): 31.0%
• Anesthesia-related arrests:
  • 11.5% of cases 

What is maternal cardiac arrest?

Maternal cardiac arrest refers to the cessation of effective cardiac output during pregnancy or postpartum, resulting in loss of perfusion to vital organs.

Clinical definition

• Absence of pulse or cardiac activity
• Requires Advanced Cardiac Life Support (ACLS) interventions
• Occurs during pregnancy or within 42 days postpartum (in broader definitions)

Incidence and timing

When do cardiac arrests occur?

The study revealed important timing patterns:

• 62.1% occurred after delivery
• 20.7% occurred before delivery
• 85% occurred within 12 hours postpartum
• Median onset: 26 minutes after delivery

Location of arrest

• Operating room: 81.6%
• Labor ward: 10.3%
• Post-anesthesia care unit: 4.6%

Major causes of maternal cardiac arrest

1. Obstetric hemorrhage

The leading cause of MCA:

• Accounts for 40.2% of cases
• Often associated with:
  • Placenta accreta spectrum (PAS)
  • Placental abruption
  • Surgical complications

Clinical significance:
Despite lower ROSC rates compared to AFE, patients who achieved ROSC after hemorrhagic arrest had excellent survival outcomes.

2. 
   

   Amniotic fluid embolism (AFE)

Second most common cause:

• Represents 31% of cases
• Rapid onset, often within minutes of delivery
• Characterized by:
  • Cardiovascular collapse
  • Coagulopathy
  • Hypoxemia

3. Anesthesia-related complications

Account for 11.5% of cardiac arrests

Most common mechanisms:

• High neuraxial block (6 cases)
• Bezold–Jarisch reflex
• Difficult airway and failed intubation
• Epidural dosing complications 

4. Other causes

• Acute cardiac events (e.g., myocardial infarction)
• Respiratory failure
• Venous thromboembolism
• Trauma
• Air embolism

Anesthesia-related cardiac arrest: clinical insights

The study highlights critical anesthetic risks:

High neuraxial block

• Excessive spread of spinal/epidural anesthesia
• Leads to:
  • Hypotension
  • Respiratory paralysis
  • Cardiac arrest

Risk scenarios

• Conversion of labor epidural to cesarean anesthesia
• Combined spinal-epidural techniques
• Emergency cesarean delivery

Risk factors for maternal cardiac arrest

Demographic risk factors

• Age ≥ 40 years → 6.6× higher risk
• BMI ≥ 40 kg/m² → ~3× higher risk
• Black and Asian/Pacific Islander race → increased risk

Clinical risk factors

The strongest associations included:

• Pulmonary hypertension (aOR 41.6)
• Placenta accreta spectrum (aOR 31.6)
• Ischemic heart disease (aOR 19.9)
• Stillbirth
• Hypertension and diabetes

Management of maternal cardiac arrest

Core principles

Management follows modified ACLS protocols for pregnancy, with key adaptations:

• Left uterine displacement
• Early airway management
• Rapid identification of reversible causes

Interventions used in the study

• Epinephrine: 87.4%
• Sodium bicarbonate: 52.9%
• Blood transfusion: 50.6%
• Central venous access: 35.6%
• ECMO or cardiopulmonary bypass: 16.1% 

Step-by-step emergency management

Deviations from guidelines

The study identified 18.4% of cases with deviations from recommended protocols:

Common issues

• Incorrect epinephrine dosing
• Delayed medication administration
• Delayed resuscitative cesarean delivery

Critical observation

• Only 5 out of 13 perimortem cesareans were performed within 5 minutes

Outcomes and prognosis

Survival statistics

• ROSC achieved: 77%
• 30-day survival: 67.8%

By etiology

• AFE: higher ROSC (85.2%)
• Hemorrhage: lower ROSC but strong survival after resuscitation

Long-term morbidity

• 5% required tracheostomy or gastrostomy
• Median hospital stay: 6 days 

Why this study matters

This research provides granular, real-world data not available in administrative datasets.

Major contributions

• Detailed timing of cardiac arrest
• Specific anesthetic causes identified
• Real-world adherence to guidelines
• Identification of modifiable risk factors 

Conclusion

Maternal cardiac arrest during anesthetic care remains rare but highly consequential. This landmark study reinforces that:

• Most cases are linked to hemorrhage and embolic events
• Anesthesia-related complications are significant but preventable
• Survival rates are encouraging when rapid, guideline-based care is delivered

Improving outcomes will depend on early recognition, strict adherence to ACLS protocols, and proactive management of obstetric risks.

Reference: Furdyna MJ et al. Frequency and Management of Maternal Peripartum Cardiac Arrest during Anesthetic Care: A Multicenter Retrospective Cohort Analysis. Anesthesiology. 2026;144:796-810.

Explore more about management of peripartum cardiac arrest in NYSORA’s Anesthesiology Manual. And for a digital learning experience, check out the Anesthesiology Module on NYSORA360!