Intrapartum Maternal Cardiac Arrest: A Simulation Case for Multidisciplinary Providers

A Randomized Trial Assessing the Effectiveness of High-fidelity Simulation Training in Managing Maternal Cardiac Arrest among Emergency Medical Professionals in India

Introduction

Maternal cardiac arrest is a rare but critical event that poses significant risks to both the mother and the fetus. As majority of population in India lives in the rural areas, Emergency Medical Professionals assist in childbirth in transit in ambulances. This timely assistance ensures the safe transportation of both mother and new born baby to the hospital. The aim of this study was to assess the effectiveness of high-fidelity simulation training in the management of maternal cardiac arrest among emergency medical professionals.

Methods

The randomized simulation study aimed to assess the effectiveness of high-fidelity simulation in managing maternal cardiac arrest. Two hundred and fifty emergency medical professionals were randomly assigned to 50 groups. Participants underwent a prebriefing session before engaging in simulation scenarios. After the initial scenarios, participants received a debriefing session emphasizing the standardized algorithm for maternal cardiac arrest management. A week later, participants engaged in a second simulation scenario, and their adherence to the algorithm was assessed. The data were analyzed using statistical tests, and the entire simulation session was video recorded for reliability.

Results

The results showed that participants demonstrated an improvement in managing both maternal and obstetric interventions in the posttraining scenario compared to the pretraining scenario. The successful implementation of the advanced cardiac life support algorithm and the debriefing session were key factors in improving participants' performance. However, continuous exposure and practice are necessary to maintain and enhance these skills.

Conclusion

Health-care professionals should actively seek opportunities for ongoing training and education to stay updated with the latest guidelines and advancements in managing maternal cardiac arrest.

Exploration of cardiopulmonary resuscitation teamwork training for maternal cardiac arrest using the SimMan intelligent simulation platform: A simulation teaching study

Background and Aims

Maternal cardiac arrest is the most urgent clinical event in obstetrics and can lead to serious consequences, such as maternal or fetal death. Therefore, the training of team cardiopulmonary resuscitation (CPR) skills for obstetricians is essential. The aim of this study was to investigate the effect of applying intelligent simulation to CPR in maternal cardiac arrest teamwork training for obstetricians.

Methods

Twenty-four obstetricians who participated in the "Maternal First Aid Workshop," organized by our hospital in 2018, were selected as training participants. The SimMan intelligent comprehensive patient simulator was used to train the CPR team collaboration with first-aid skills. Each team participating in the training was assessed before and after the training using a questionnaire survey.

Results

The evaluation of the results after the training showed that all four teams were qualified and that the timing of the cesarean section was 100% correct. The mean score, team collaboration score, and chest compression fraction were significantly higher than before training. Teamwork CPR assessment time, interruption time of chest compressions, and artificial airway establishment time were significantly shorter than before training. The questionnaire survey showed that 95.8% of the physicians reported that the training was rewarding and helpful to their clinical work, and 100% of the physicians believed that obstetricians require similar training.

Conclusion

Using the SimMan intelligent comprehensive patient simulator to train obstetricians for CPR of maternal cardiac arrest teamwork first-aid skills can significantly improve the training effect, clinical first-aid skills, and teamwork awareness.

Perimortem Cesarean Section in a Patient with Intrapartum Cardiorespiratory Arrest Due to a Massive Amniotic Fluid Embolism

We report and discuss the case of a 29-year-old tercigravida with intrapartum cardiorespiratory arrest due to a massive amniotic fluid embolism and disseminated intravascular coagulopathy. Perimortem caesarean section with B-Lynch compression uterine suture with simultaneous fetal and maternal resuscitation were performed with a favorable outcome for both the mother and the child.

Impact of foeto-maternal resuscitation and perimortem caesarean section simulation training: An opinion survey of healthcare participants

Background:

The incidence of maternal cardiac arrest is rising in recent years. Medical staff generally lack the experience of performing resuscitation on pregnant patients. Maternal cardiac arrest and perimortem caesarean section simulation training was newly introduced in the Advanced Life Support in Obstetrics provider courses in Hong Kong since April 2021.

Objective:

To evaluate the course participants’ opinions on maternal cardiac arrest simulation training.

Methods:

A questionnaire survey was conducted for all participants in the Advanced Life Support in Obstetrics provider course in April 2021 to assess their opinions on the usefulness of this training.

Results:

There were four Advanced Life Support in Obstetrics provider courses in April 2021 with 36 participants in each course, and 137 questionnaires were received at the end of the course. The response rate was 137/144 (95.1%). After excluding the questionnaires with incomplete information, 134 questionnaires were included for final analysis. Almost all of the participants agreed that the maternal cardiac arrest simulation training could help them in their work (97.8%), could improve their knowledge and skill (98.5%) and could improve team training and co-ordination (97.0%). The majority of them (97.0%) felt more confident in managing maternal cardiac arrest after the training, and 97.8% of participants felt that the perimortem caesarean section model was useful for training. Around 80% of the participants would recommend this course to their colleagues. There were no significant differences in opinions on the usefulness of this training among participants with regard to their specialty, whether they were doctors or nurses, their years of experience and the specific hospital settings.

Conclusions:

Maternal cardiac arrest simulation training was highly valued by all levels of obstetric, emergency medicine and anaesthesia staff in both public and private hospitals.

Airborne Isolation Cardiac Arrest: A Simulation Program for Interdisciplinary Code Blue Team Training

INTRODUCTION

In-hospital cardiac arrest in patients with COVID-19 presents significant challenges to health care teams. Airborne precautions can delay patient care, place providers at high risk of virus exposure, and exacerbate an already stressful environment. Within the constraints of an ongoing pandemic, an efficient educational program is required to prepare health care teams for airborne isolation code blue.

METHODS

This simulation was conducted in a room on the target unit using a CPR manikin to represent the patient. A "talk-through walk-through" scripted simulation directed learners (internal medicine residents, unit nurses, and other code blue responders) through a resuscitation using an airborne isolation code blue protocol. Key scripted events prompted role identification, communication, and item transfer. Learners self-assessed their airborne isolation code blue knowledge and skills and their confidence in providing quality care while maintaining safety using a pre-/posttraining 5-point Likert-scale survey.

RESULTS

We trained 100 participants over a 5-month period, with 65 participants surveyed (43 respondents; 16 residents, 22 nurses). Following training, participants had a statistically significant (p < .001) increase in percentage selecting agree/strongly agree for all statements related to knowledge and skills specific to airborne isolation code blue protocol, as well as confidence in providing care while keeping themselves and their colleagues safe.

DISCUSSION

Our simulation program allowed a small number of educators to feasibly train a large number of learners, let learners practice required skills, and improved learners' self-assessed knowledge, skills, and confidence regarding quality and safety of care.

Updates on Simulation in Obstetrical Anesthesiology Through the COVID-19 Pandemic

Simulation has played a critical role in medicine for decades as a pedagogical and assessment tool. The labor and delivery unit provides an ideal setting for the use of simulation technology. Prior reviews of this topic have focused on simulation for individual and team training and assessment. The COVID-19 pandemic has provided an opportunity for educators and leaders in obstetric anesthesiology to rapidly train health care providers and develop new protocols for patient care with simulation. This review surveys new developments in simulation for obstetric anesthesiology with an emphasis on simulation use during the COVID-19 pandemic.

Changing the landscape of obstetric resident education in low- and middle-income countries using simulation-based training

OBJECTIVE

To evaluate simulation-based training (SBT) in low- and-middle-income countries (LMIC) and the long-term retention of knowledge and self-efficacy.

METHODS

We conducted an SBT course on the management of postpartum hemorrhage (PPH), shoulder dystocia (SD), and maternal cardiac arrest (MCA) in three government teaching hospitals in Guatemala. We evaluated changes in knowledge and self-efficacy using a multiple-choice questionnaire for 46 obstetrics/gynecology residents. A paired Student's t test was used to analyze changes at 1 week and 6 months after the SBT.

RESULTS

There was an increase in scores in clinical knowledge of MCA (p < 0. 001, 95% confidence interval [CI] 0.81-1.49) and SD (p < 0.001, 95% CI 0.41-1.02) 1 week after SBT, and a statistically insignificant increase in PPH scores (p = 0.617, 95% CI -0.96 to 0.60). This increase in scores was maintained after 6 months for MCA (p < 0.001, 95% CI 0.69-1.53), SD (p = 0.02 95% CI 0.07-0.85), and PPH (p = 0.04, 95% CI 0.01-1.26). For MCA and SD, the levels of self-efficacy were increased 1 week following training (p < 0.001, 95% CI 0.83-2.30 and p = 0.008, 95% CI 0.60-3.92, respectively), and at 6 months (p < 0.001, 95% CI 0.79-2.42 and p = 0.006, 95% CI 0.66-3.81, respectively). There was a slight increase in PPH self-efficacy scores 1 week after SBT (p = 0.73, 95% CI -6.05 to 4.41), maintained after 6 months (p = 0.38, 95% CI -6.85 to 2.85).

CONCLUSION

SBT was found to be an effective and feasible method to increase short- and long-term clinical knowledge and self-efficacy of obstetric emergencies in LMIC.