///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

The "5-Minute Rule" for Perimortem Cesarean Delivery: Should the Patient be Moved to the Operating Room?

Abstract Number: 270
Abstract Type: Original Research

Steven Lipman MD1 ; Brendan Carvalho FRCA2; Sheila Cohen FRCA3

Introduction: The "5-minute rule" is recommended by the American Heart Association when intrauterine gestation is > 20 weeks. If initial resuscitation is not effective during cardiac arrest in pregnancy, delivering the fetus within 5 min may facilitate maternal and fetal survival. We used data obtained from ongoing, timed "stat" cesarean (CS) drills at our institution to test our hypothesis that during an actual maternal arrest, the time taken in moving the patient to the operating room (OR) would preclude delivery of the fetus within 5 min.

Methods: The scenario starts in a labor and delivery room (LDR) with an otherwise healthy G2P1 patient (a Noelle manikin) presenting for vaginal birth after cesarean (VBAC). The nurse is given report regarding VBAC status, and time zero starts after a fetal heart rate of 60 bpm is detected. Other participants include: anesthesia resident, obstetric attending, obstetric resident, obstetric scrub tech, desk clerk, and 3 additional nurses. Outcomes included: 1) time required to exit the LDR; 2) transit time to the operating room (OR); and, 3) time from arrival in the OR until incision.

Results:

Data from 8 drills of this ongoing study are presented in Table 1. The median time from the start of the scenario until surgical incision was 9 min 31 seconds.

Discussion:

Our drill involved a stat CS in an awake rather than arrested patient. However, had our drills involved a maternal cardiac arrest, no patient would have been delivered within 5 min. This is notable because: 1) our Labor & Delivery Ward is compact, with 3 dedicated OR suites located adjacent to 10 LDRs; 2) participants were not nave to the scenario and knew they were being timed; 3) our manikin was lighter and easier to transport than a real patient; and 4) we used the closest OR - in a real event it may have been occupied. There is ongoing debate whether to move to the OR or perform a perimortem CS in the LDR in the case of a maternal cardiac arrest. Our results suggest that even in an optimal setting, delivery within 5 min cannot be achieved if the patient is moved to the OR. Our findings support delivery in the patients room.

Refs:

Obstet Gynecol 1986;68:571-6

Circulation 2005;112;150-153

Am J Obstet Gynecol 2005;192:1916-1920

Crit Care Med 2005; 33 (10 Suppl):S256-258



SOAP 2009