A Randomized Trial Comparing the Labor Room vs. Operating Room for Perimortem Cesarean Delivery During Simulated Cardiac Arrest
Abstract Number: 142
Abstract Type: Original Research
Introduction: In the event of cardiac arrest during pregnancy (gestation > 20 weeks), the American Heart Association recommends incision within 4 min and delivery within 5 min to improve maternal survival. The study objective was to compare the labor (LDR) and operating room (OR) settings for perimortem cesarean delivery (CD) during simulated maternal arrests.
Methods: 14 multidisciplinary teams comprised of 4 nurses, 2 obstetricians, and 1 anesthesiologist were randomized (n=7 per group) to deliver in the LDR or OR during perimortem cesarean drills. The scenario utilized a manikin with an abdominal model overlay that allowed for simulated CD and began in the LDR with maternal cardiopulmonary arrest and fetal bradycardia. The primary outcome was time to incision rather than delivery because the abdominal model was quite thin. Secondary outcomes included times to important milestones, percentage of tasks completed and type of incision. Appropriate statistical tests were utilized with P<0.05 considered significant.
Results: The median (IQR) time from time zero to incision was 4:25 (3:59-4:50) min:secs in the LDR group and 7:53 (7:18-8:57) min:secs in the OR group (P=0.004). 57% of LDR teams and 14% of OR teams were able to deliver within 5 min. Times to other important milestones are in the table. Time (mean ± SD) required for transport to the OR was 50 ± 13 secs. A vertical incision was used in 86% of LDR and 43% of OR cases (P=0.094).
Discussion: Perimortem CD in the LDR was significantly faster than in the OR. Delivery within 5 min was challenging in either location despite optimal conditions (teams were familiar with simulation, knew the scenario mandated CD and were aware of being timed; the manikin was light and easily moved; and timing only started when the nurse was completely prepared). Our findings suggest that perimortem CD during an actual maternal arrest would require greater than 5 min, and support performing perimortem CD in the LDR rather than relocating to the OR.
Am J Obstet Gynecol 2005;192:1916
Circulation 2010;122;Part 12.3,S833-38