Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study [11L]

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Abstract

INTRODUCTION:

There is a dearth of literature in simulation-based emergent maternal-fetal care scenarios for training residents in an accredited Obstetrics & Gynecologic (OBGYN) residency program.

METHODS:

A prospective pre/post-test design was implemented in an onsite medical simulation laboratory. A didactic lecture, medical simulation, and simulation debriefing occurred for maternal cardiac arrest following magnesium toxicity, maternal pulmonary embolism, splenic laceration caused by intimate partner violence, and placental abruption. Pre and post individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of emergency management competencies (EMC) evaluated on video review by content experts in Emergency Medicine, OBGYN and MFM. All data were analyzed using SPSS 22.0.

RESULTS:

Average participant age was 29.6±1.1 years (n=9). Significant differences were noted in individual KT scores pre: 58.9±8.9 versus post: 72.8±6.1, P=.01 and CS total scores pre: 22.2±6.4 versus post: 29.9±3.4, P=.007. Significant differences were noted in group EMC of airway management, P=.008; appropriate cycles of drug shock-CPR, P=.008; let uterine displacement, P=.008; and causes of cardiac arrest in pregnancy, P=.008. Non-significant differences were noted with EMC not being met for: administration of appropriate drugs/doses, P=.074; chest compressions, P=.074; bag-mask ventilation before intubation, P=.074; and return of spontaneous circulation identification, P=.074. Groups remained non-competent in providing high-quality cardiopulmonary resuscitation at all times, assigning team leader roles, or considering therapeutic hypothermia.

CONCLUSION:

The study demonstrated improved OBGYN resident baseline knowledge, confidence, and competence in several areas of the management of third trimester maternal cardiac arrest.

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