Intrapartum Maternal Cardiac Arrest: A Simulation Case for Multidisciplinary Providers

Abstract

Introduction: Cardiac arrest in pregnancy is rare. Advanced Cardiovascular Life Support courses rarely address interventions specific to obstetric patients, and knowledge gaps are frequent among providers. The Society for Obstetric Anesthesia and Perinatology and American Heart Association have published guidelines regarding management of cardiac arrest in pregnancy, and interdisciplinary simulation training has been advocated to reinforce key management points for this clinical scenario.

Methods: In situ multidisciplinary simulation training was implemented for anesthesia and maternal fetal medicine fellows and obstetric nurses at our hospital. The case was amniotic fluid embolism in a 35-year-old parturient at term. The patient had a witnessed seizure before cardiovascular collapse. Learners were expected to initiate high-quality cardiopulmonary resuscitation and perform a perimortem cesarean delivery within 5 minutes while demonstrating clear communication with each other. The case required a labor room, high-fidelity mannequin, defibrillator, code cart, cesarean section instruments, and simulated medications and intravenous fluids.

Results: Participants comprised two obstetric anesthesia fellows, three maternal fetal medicine fellows, and three obstetric nurses. Positive feedback about the training and increased perceptions of self-efficacy were received. Potential systems issues were detected and corrected because of the training, highlighting the value of in situ drills.

Discussion: We found it challenging to implement more frequent multidisciplinary sessions, but participants found the experience highly rewarding. We hope to expand the training to all physicians and nurses covering the unit on a regular basis. Modified scenario versions are being used for nursing-only and obstetric resident-only simulations during protected teaching time for those services.

Keywords: Manual Left Uterine Displacement; Maternal Cardiac Arrest; Perimortem Cesarean Section.