• Caroline Leech, Tim Nutbeam, Justin Chu, Marian Knight, Kim Hinshaw, Tracy-Louise Appleyard, Stephanie Cowan, Keith Couper, and Joyce Yeung.
• University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK; The Air Ambulance Service, Blue Skies House, Rugby CV21 3RQ, UK; West Midlands Ambulance Service, Sandwell Hub, Shidas Lane, Oldbury B69 2GR, UK; Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK. Electronic address: Caroline.Leech@uhcw.nhs.uk.
• Resuscitation. 2024 Dec 29: 110479110479.

ObjectiveTo examine maternal and neonatal outcomes following Resuscitative Hysterotomy for out of hospital cardiac arrest (OHCA) and to compare with timing from cardiac arrest to delivery.MethodsThe review was registered with PROSPERO (CRD42023445064). Studies included pregnant women with out of hospital cardiac arrest and resuscitative hysterotomy performed (in any setting) during cardiac arrest. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), from inception to 25th May 2024, restricted to humans. We included randomised controlled trials, observational studies, cases series or case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias using validated tools. Data are summarised in a narrative synthesis.ResultsWe included 42 publications (one cohort study, three case series and 38 case reports) including a total of 66 women and 68 neonates. Maternal and newborn survival to hospital discharge was 4.5% and 45.0% respectively. The longest duration from collapse to resuscitative hysterotomy for maternal survival with normal neurological function was 29 min and for neonates was 47 min. There were reported neonatal survivors born at 26 weeks gestation with good outcomes. The certainty of evidence was very low due to risk of bias.ConclusionThere are low rates of maternal survival following resuscitative hysterotomy for OHCA. There are documented neonatal survivors after extended periods of maternal resuscitation, and at extremely preterm gestations (<28 weeks). Further prospective research should assess both maternal and neonatal outcomes to better inform future clinical practice.Copyright © 2024 Elsevier B.V. All rights reserved.

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