Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study

Abstract

Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9 ± 8.9 versus post: 72.8 ± 6.1, p = 0.01) and CS total scores (pre: 22.2 ± 6.4 versus post: 29.9 ± 3.4, p = 0.007). Significant differences were noted in airway management, p = 0.008; appropriate cycles of drug/shock-CPR, p = 0.008; left uterine displacement, p = 0.008; and identifying causes of cardiac arrest, p = 0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p = 0.074; chest compressions, p = 0.074; bag-mask ventilation before intubation, p = 0.074; and return of spontaneous circulation identification, p = 0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency.

Maternity Nurses’ Performance Regarding Cardiopulmonary Resuscitation During Pregnancy: Simulation Based Intervention

“…Tool II-maternity nurse practice observational checklist It was constructed by the researcher after reviewing relevant literature. It was adopted from (Hui et a, 2011, Rodrigues et al, 2014, and (Adams et al, 2016). It was concerned with assessing the maternity nurse practice regarding cardiopulmonary resuscitation during pregnancy.…”

A novel biosimulation task trainer for the deliberate practice of resuscitative hysterotomy

“…Previously attempted models have relied on expensive simulation equipment as the basis for their models. One model in the literature [ 4 ] is based on the Gaumard NOELLE unit, which costs $4295 at the time of this paper alone ( http://www.gaumard.com/s550 ). By contrast, the simulation pelvis used in this study was much cheaper ($595), including the simulation baby ( http://www.gaumard.com/s500 ), and could be used several times for multiple learners.…”

“…One model described in the literature [ 6 ] requires latex to dry overnight as a single step, in addition to having gelatin set for 2 h at a time. Other published studies [ 4 , 6 ] do not specify a construction time. The study investigators propose that the quick production and rapid portability across different learning spaces make this an efficacious model for learning resuscitative hysterotomy.…”

“…To date, there are only a few commercially manufactured resuscitative hysterotomy task trainers available for training, further complicated by costly components, maintenance costs, and task trainer availability [ 4 – 6 ]. To address these issues, the authors propose a novel training program using a homegrown, high-realism, task trainer that can be easily inserted into an inexpensive childbirth simulator to teach emergency medicine (EM) residents resuscitative hysterotomy.…”

院内発生の妊婦心肺停止症例に対応するための体制整備(System development and simulation training for management of in–hospital maternal cardiac arrest)

“…実施までのフローシートと連絡経路を作成し，それをシミュレーションで実施することで改めて問題点を抽出することができた。Adamsらは，産婦人科研修期間の間に，PMCDも含んだ母体心停止のシミュレーションを実施することで，実施前後で知識やPMCDの時間短縮に寄与する可能性を示唆している 。当院でもシミュレーションを繰り返すことでPMCDまでの時間短縮がなされた。患者の移動手段，連絡経路などの問題点も改めて浮き彫りになった。…”