ReviewEBioMedicine2016
Maternal collapse: Challenging the four-minute rule.
Review in EBioMedicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 58 citations in OpenAlex.
- Advanced resuscitation strategies for cardiac arrest in pregnancy: a systematic review.BMC cardiovascular disorders · 2026Pooled it
- Maternal collapse in pregnancy: evolving aetiology and healthcare system response.Case reports in women's health · 2025Article
- Caring for Two: Management of the Critically Ill Cardiac Patient During Pregnancy.JACC. Advances · 2025Review
- Cardiac arrest in pregnancy with successful stabilization and delivery on veno-arterial extracorporeal membrane oxygenation: a case report.European heart journal. Case reports · 2024Article
- [Severe traffic accident on the hospital grounds].Die Anaesthesiologie · 2024Article
- [Prehospital perimortem cesarean section during cardiopulmonary resuscitation for traumatic cardiac arrest : Case report and lessons learned].Unfallchirurgie (Heidelberg, Germany) · 2023Article
- Singapore Advanced Cardiac Life Support Guidelines 2021.Singapore medical journal · 2021Article
- [Cardiac arrest under special circumstances].Notfall & rettungsmedizin · 2021Review
- Resuscitative hysterotomy for maternal collapse in a triplet pregnancy.BMJ case reports · 2020Article
- Two cases of low birth weight infant survival by prehospital emergency hysterotomy.Scandinavian journal of trauma, resuscitation and emergency medicine · 2017Article
- How can we Challenge the Four-minute Rule?EBioMedicine · 2016Article
- Cardiac arrest and resuscitative cesarean section - A brief review.Journal of anaesthesiology, clinical pharmacologyReview
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the "four-minute rule": If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule.
methodsA literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the "four-minute rule." Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals.
resultsBoth maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4min. Skin incision to birth intervals of 1min occurred in only 10% of women.
conclusionOnce a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4min for restoration of the maternal pulse. Birth within 1min from the start of the incision is uncommon in these circumstances.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.