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Tanaka H, Matsunaga S, Furuta M, Kato R, Takahashi S, Takeda J, Nakao M, Nakamura E, Nii M, Yamashita T, Yamahata Y, Enomoto N, Tsuji M, Baba S, Hosokawa Y, Maenaka T, Sakurai A. Maternal cardiopulmonary resuscitation. J Obstet Gynaecol Res 2023; 49:54-67. [PMID: 36257320 DOI: 10.1111/jog.15466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 01/20/2023]
Abstract
The perinatal resuscitation history in Japan is short, with the earliest efforts in the field of neonatology. In contrast, the standardization and dissemination of maternal resuscitation is lagging. With the establishment of the Maternal Death Reporting Project and the Maternal Death Case Review and Evaluation Committee in 2010, with the aim of reducing maternal deaths, the true situation of maternal deaths came to light. Subsequently, in 2015, the Japan Council for the Dissemination of Maternal Emergency Life Support Systems (J-CIMELS) was established to educate and disseminate simulations in maternal emergency care; training sessions on maternal resuscitation are now conducted in all prefectures. Since the launch of the project and council, the maternal mortality rate in Japan (especially due to obstetric critical hemorrhage) has gradually decreased. This has been probably achieved due to the tireless efforts of medical personnel involved in perinatal care, as well as the various activities conducted so far. However, there are no standardized guidelines for maternal resuscitation yet. Therefore, a committee was set up within the Japan Resuscitation Council to develop a maternal resuscitation protocol, and the Guidelines for Maternal Resuscitation 2020 was created in 2021. These guidelines are expected to make the use of high-quality resuscitation methods more widespread than ever before. This presentation will provide an overview of the Guidelines for Maternal Resuscitation 2020.
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Affiliation(s)
- Hiroaki Tanaka
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | | | - Marie Furuta
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Rie Kato
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Shinji Takahashi
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Jun Takeda
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Masahiro Nakao
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Eishin Nakamura
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Masafumi Nii
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | | | | | - Naosuke Enomoto
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Makoto Tsuji
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Shiniji Baba
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Yuki Hosokawa
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Takahide Maenaka
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Atsushi Sakurai
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
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Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A. Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses. BMC Pregnancy Childbirth 2022; 22:159. [PMID: 35216559 PMCID: PMC8881850 DOI: 10.1186/s12884-021-04334-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations. Results We included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°–30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position. Conclusions Given that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest.
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Affiliation(s)
- Naosuke Enomoto
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tomoyuki Yamashita
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Marie Furuta
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, Mie University / Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Edmond S W Ng
- London School of Hygiene & Tropical Medicine, London, UK
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynaecology, Saitama Medical Centre, Saitama Medical University, Saitama, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
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Chauvin A, Truchot J, Bafeta A, Pateron D, Plaisance P, Yordanov Y. Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review. Intern Emerg Med 2018; 13:433-444. [PMID: 29147942 DOI: 10.1007/s11739-017-1770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/10/2017] [Indexed: 11/27/2022]
Abstract
The number of trials assessing Simulation-Based Medical Education (SBME) interventions has rapidly expanded. Many studies show that potential flaws in design, conduct and reporting of randomized controlled trials (RCTs) can bias their results. We conducted a methodological review of RCTs assessing a SBME in Emergency Medicine (EM) and examined their methodological characteristics. We searched MEDLINE via PubMed for RCT that assessed a simulation intervention in EM, published in 6 general and internal medicine and in the top 10 EM journals. The Cochrane Collaboration risk of Bias tool was used to assess risk of bias, intervention reporting was evaluated based on the "template for intervention description and replication" checklist, and methodological quality was evaluated by the Medical Education Research Study Quality Instrument. Reports selection and data extraction was done by 2 independents researchers. From 1394 RCTs screened, 68 trials assessed a SBME intervention. They represent one quarter of our sample. Cardiopulmonary resuscitation (CPR) is the most frequent topic (81%). Random sequence generation and allocation concealment were performed correctly in 66 and 49% of trials. Blinding of participants and assessors was performed correctly in 19 and 68%. Risk of attrition bias was low in three-quarters of the studies (n = 51). Risk of selective reporting bias was unclear in nearly all studies. The mean MERQSI score was of 13.4/18.4% of the reports provided a description allowing the intervention replication. Trials assessing simulation represent one quarter of RCTs in EM. Their quality remains unclear, and reproducing the interventions appears challenging due to reporting issues.
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Affiliation(s)
- Anthony Chauvin
- Service d'Accueil des Urgences, Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France.
- Faculté de Médecine, Université Diderot, Paris, France.
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France.
| | - Jennifer Truchot
- Service d'Accueil des Urgences, Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
- Faculté de Médecine, Université Diderot, Paris, France
- Ilumens Simulation Department, Paris Descartes University, 45 rue des Saint Pères, 75006, Paris, France
| | - Aida Bafeta
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France
| | - Dominique Pateron
- Sorbonne Universités, UPMC Paris Univ-06, Paris, France
- Service des Urgences-Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Patrick Plaisance
- Service d'Accueil des Urgences, Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
- Faculté de Médecine, Université Diderot, Paris, France
| | - Youri Yordanov
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), METHODS Team, Hotel-Dieu Hospital, Paris, France
- Sorbonne Universités, UPMC Paris Univ-06, Paris, France
- Service des Urgences-Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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Dohi S, Ichizuka K, Matsuoka R, Seo K, Nagatsuka M, Sekizawa A. Coronary perfusion pressure and compression quality in maternal cardiopulmonary resuscitation in supine and left-lateral tilt positions: A prospective, crossover study using mannequins and swine models. Eur J Obstet Gynecol Reprod Biol 2017; 216:98-103. [DOI: 10.1016/j.ejogrb.2017.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/14/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Pecher S, Williams E. Out-of-hospital cardiac arrest in pregnancy with good neurological outcome for mother and infant. Int J Obstet Anesth 2017; 29:81-84. [DOI: 10.1016/j.ijoa.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022]
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Eldridge AJ, Ford R. Perimortem caesarean deliveries. Int J Obstet Anesth 2016; 27:46-54. [PMID: 27103543 DOI: 10.1016/j.ijoa.2016.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/25/2016] [Indexed: 11/17/2022]
Abstract
Although cardiac arrest in pregnancy is rare, it is important that all individuals involved in the acute care of pregnant women are suitably trained, because the outcome for both mother and fetus can be affected by the management of the arrest. Perimortem caesarean delivery was first described in 715 BC. Initially the procedure was performed principally for religious or political reasons. Although the potential for fetal survival was proposed, it was rarely successful, probably because the delivery was delayed until maternal death was established. However, in recent decades, case reports have suggested improved maternal as well as fetal survival if perimortem caesarean section was performed rapidly once maternal arrest has occurred. While evidence for this is largely based on case reports, the physiological advantages including removing inferior caval obstruction, and hence improving venous return to the heart, reducing oxygen requirement and improving chest compliance appear compelling. Factors that reduce errors and minimise the delay in performance of caesarean delivery are discussed, in particular the importance of training, organizational factors within a hospital and the use of prompts during an arrest. While evidence is limited, it is probable that both maternal and fetal survival are improved with early delivery by perimortem caesarean delivery. More importantly, no evidence was found from case report reviews that either maternal or fetal survival was worsened. Perimortem caesarean delivery therefore remains a key consideration in the management of maternal arrest from the mid second trimester.
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Affiliation(s)
- A J Eldridge
- Anaesthetic Department, Queen Alexandra Hospital, Portsmouth, Hampshire, UK.
| | - R Ford
- Anaesthetic Department, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
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Song Y, Oh J, Chee Y, Cho Y, Lee S, Lim TH. Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study. Anaesthesia 2015; 70:1235-41. [PMID: 26349025 DOI: 10.1111/anae.13222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/30/2022]
Abstract
Feedback devices have been shown to improve the quality of chest compression during cardiopulmonary resuscitation for patients in the supine position, but no studies have reported the effects of feedback devices on chest compression when the chest is tilted. Basic life support-trained providers were randomly assigned to administer chest compressions to a manikin in the supine, 30° left lateral tilt and 30° semirecumbent positions, with or without the aid of a feedback device incorporated into a smartphone. Thirty-six participants were studied. The feedback device did not affect the quality of chest compressions in the supine position, but improved aspects of performance in the tilted positions. In the lateral tilted position, the median (IQR [range]) chest compression rate was 99 (99-100 [96-117]) compressions.min(-1) with and 115 (95-128 [77-164]) compressions.min(-1) without feedback (p = 0.05), and the proportion of compressions of correct depth was 55 (0-96 [0-100])% with and 1 (0-30 [0-100])% without feedback (p = 0.03). In the semirecumbent position, the proportion of compressions of correct depth was 21 (0-87 [0-100])% with and 1 (0-26 [0-100])% without feedback (p = 0.05). Female participants applied chest compressions at a more accurate rate using the feedback device in the lateral tilted position but were unable to increase the chest compression depth, whereas male participants were able to increase the force of chest compression using the feedback device in the lateral tilted and semirecumbent positions. We conclude that a feedback device improves the application of chest compressions during simulated cardiopulmonary resuscitation when the chest is tilted.
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Affiliation(s)
- Y Song
- School of Electrical Engineering, University of Ulsan, Ulsan, Korea
| | - J Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Y Chee
- School of Electrical Engineering, University of Ulsan, Ulsan, Korea
| | - Y Cho
- Department of Emergency Medicine, College of Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - S Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - T H Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Comparisons of the Pentax-AWS, Glidescope, and Macintosh Laryngoscopes for Intubation Performance during Mechanical Chest Compressions in Left Lateral Tilt: A Randomized Simulation Study of Maternal Cardiopulmonary Resuscitation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:975649. [PMID: 26161426 PMCID: PMC4487700 DOI: 10.1155/2015/975649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/25/2014] [Indexed: 12/02/2022]
Abstract
Purpose. Rapid advanced airway management is important in maternal cardiopulmonary resuscitation (CPR). This study aimed to compare intubation performances among Pentax-AWS (AWS), Glidescope (GVL), and Macintosh laryngoscope (MCL) during mechanical chest compression in 15° and 30° left lateral tilt. Methods. In 19 emergency physicians, a prospective randomized crossover study was conducted to examine the three laryngoscopes. Primary outcomes were the intubation time and the success rate for intubation. Results. The median intubation time using AWS was shorter than that of GVL and MCL in both tilt degrees. The time to visualize the glottic view in GVL and AWS was significantly lower than that of MCL (all P < 0.05), whereas there was no significant difference between the two video laryngoscopes (in 15° tilt, P = 1; in 30° tilt, P = 0.71). The progression of tracheal tube using AWS was faster than that of MCL and GVL in both degrees (all P < 0.001). Intubations using AWS and GVL showed higher success rate than that of Macintosh laryngoscopes. Conclusions. The AWS could be an appropriate laryngoscope for airway management of pregnant women in tilt CPR considering intubation time and success rate.
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The pregnant heart: cardiac emergencies during pregnancy. Am J Emerg Med 2015; 33:573-9. [DOI: 10.1016/j.ajem.2015.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/23/2022] Open
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Lipman S, Cohen S, Einav S, Jeejeebhoy F, Mhyre JM, Morrison LJ, Katz V, Tsen LC, Daniels K, Halamek LP, Suresh MS, Arafeh J, Gauthier D, Carvalho JCA, Druzin M, Carvalho B. The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Management of Cardiac Arrest in Pregnancy. Anesth Analg 2014; 118:1003-16. [DOI: 10.1213/ane.0000000000000171] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gabbott DA. Uterine displacement during CPR in the pregnant patient--why bother? Resuscitation 2013; 84:267-8. [PMID: 23375421 DOI: 10.1016/j.resuscitation.2013.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 01/21/2013] [Indexed: 11/18/2022]
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