Intrapartum Maternal Cardiac Arrest: A Simulation Case for Multidisciplinary Providers

Area of Science:

• Obstetrics
• Anesthesiology
• Emergency Medicine

Background:

• Cardiac arrest during pregnancy is infrequent, and standard Advanced Cardiovascular Life Support training often lacks obstetric-specific interventions.
• Knowledge gaps persist among healthcare providers regarding the management of pregnant patients experiencing cardiac arrest.
• Guidelines exist for managing cardiac arrest in pregnancy, emphasizing the need for specialized training.

Purpose of the Study:

• To evaluate the effectiveness of in situ multidisciplinary simulation training for managing cardiac arrest in pregnancy.
• To enhance provider self-efficacy and identify system-level improvements in obstetric emergency response.

Main Methods:

• An in situ multidisciplinary simulation was conducted involving anesthesia fellows, maternal-fetal medicine fellows, and obstetric nurses.
• The scenario simulated an amniotic fluid embolism leading to cardiovascular collapse in a term parturient.
• Participants were trained to perform high-quality cardiopulmonary resuscitation and perimortem cesarean delivery within 5 minutes, emphasizing communication.

Main Results:

• The training involved two obstetric anesthesia fellows, three maternal-fetal medicine fellows, and three obstetric nurses.
• Participants reported positive feedback and increased self-efficacy following the simulation.
• The simulation successfully identified and allowed for correction of potential systems issues within the obstetric unit.

Conclusions:

• In situ multidisciplinary simulation is a valuable tool for improving the management of cardiac arrest in pregnancy.
• Despite implementation challenges, the training experience was highly rewarding for participants.
• Expansion of this simulation training to all relevant healthcare providers is recommended for regular reinforcement of critical skills.