Obstetric Life Support Education for Maternal Cardiac Arrest: A Randomized Clinical Trial

Abstract

Importance: Management of maternal cardiac arrest (MCA) requires understanding the unique physiology of pregnancy and modifications to life support. Health care professionals have historically demonstrated inadequate knowledge and skills necessary to treat MCA.

Objective: To evaluate the effect of Obstetric Life Support (OBLS) education on health care professionals' cognitive performance, skills, and self-efficacy in managing MCA.

Design, setting, and participants: In this single-masked randomized clinical trial, 46 health care professionals, including emergency medical service and hospital staff representing diverse specialties, were randomized to intervention or control groups at a single academic medical center in Farmington, Connecticut between May 1, 2022, and July 23, 2023.

Intervention: The intervention group received OBLS education, which included a blended learning curriculum with simulation-based training on common maternal medical emergencies that lead to MCA. Participants were assessed for knowledge, confidence, and skills (eg, megacode scores as team leaders during MCA simulations). Intervention participants were compared with control group participants who received no OBLS education.

Main outcomes and measures: The primary outcome was cognitive scores. Secondary outcomes included megacode scores rated by experienced OBLS instructors masked to assignment groups, combined assessment pass rates, and cognitive and confidence scores at baseline and 6 and 12 months after education. Data were analyzed from January 2024 to May 2024.

Results: Forty-six participants (mean [SD] age, 41.1 [16.2] years; 24 [52%] women) were randomized. Despite most participants holding certification in basic and advanced cardiac life support, significant between-group differences were identified in knowledge, skills, and confidence. Mean (SD) cognitive scores were 79.5% (9.4%) in the intervention group vs 63.4% (12.3%) in the control group (P < .001). Mean (SD) megacode skills were higher in the intervention vs control group (91.0% [5.0%] vs 61.0% [12.0%], P < .001), as were confidence scores (72.7 [13.3] vs 56.2 [17.9] points, P = .002). Combined assessment pass rates were 90% in the intervention group compared with 10% in the control group (P < .001).

Conclusions and relevance: In this randomized clinical trial, OBLS education significantly improved health care professionals' knowledge, skills, and confidence in managing MCA. These findings underscore the urgent need for implementation of a standardized MCA curriculum nationwide, especially as the US continues to face unacceptably high maternal mortality rates.

Trial registration: ClinicalTrials.gov Identifier: NCT05355519.

Figure 1.. CONSORT Flow Diagram and Study Design and Timing of Assessments

OBLS indicates Obstetric Life Support.

Figure 2.. Megacode Scores According to Study Group and Environment

Each test item was on a Likert scale, with a final score tabulated by adding item scores and converting to a 100-point scale, with 1 indicating lowest performance and 100 indicating highest performance. The ends of the boxes represent the 25th and 75th percentiles; horizontal line inside the box, the mean; whiskers, the upper and lower adjacent values; diamond, mean; open circles and plus signs, points that fall beyond the whiskers.

Figure 3.. Mean Cognitive and Confidence Scores by Study Arm and Time

Each item was equally weighted, and a final score was tabulated by adding item scores and converting to a 100-point scale, with 1 indicating no confidence and 100 indicating total confidence. Error bars indicate 95% CIs.