Management of maternal cardiac arrest: assessing the effectiveness of different teaching interventions on anesthesia residents' performance using high-fidelity simulation
Abstract Number: 166
Abstract Type: Original Research
Introduction: Maternal cardiac arrest in pregnancy is rare, occurring in between 1 in 20,000 and 1 in 30,000 pregnancies.(1,2) It is associated with poor maternal and fetal outcomes unless CPR is initiated rapidly and the fetus delivered promptly.(3) Our study objective was to assess anesthesia residents' performance in a maternal cardiac arrest scenario using high-fidelity simulation, both before and after a didactic teaching or electronic-learning program. We hypothesized that teaching improves their management of such cases and results in a faster time to perimortem cesarean delivery, with a greater improvement seen in the e-learning group.
Methods: We recruited 20 anesthesia residents from Postgraduate Years 2-4. They participated in a simulated case of maternal cardiac arrest and were assessed on technical and non-technical skills (Anaesthetists’ Non-Technical Skills [ANTS]; scale 1-4, 1=poor, 4=excellent) (4). They were randomized to receive either a didactic teaching or electronic learning session and will return to perform a second simulation after one month.
Results: Many residents did not perform required life support tasks or make the recommended modifications for pregnancy. Non-technical skills were generally “marginal” (Table 1). 75% requested cesarean delivery: of those who did, 13% did not do concurrent CPR and 13% asked to move the patient to the OR. The median (IQ range) time to incision (mins.secs) was 4.23 (3.59, 5.03).
Discussion: Even for residents who are ACLS-trained and attend “code blue” arrest calls, there is a lack of knowledge in life support skills and the advised modifications for pregnancy. We look forward to examining differences in the residents’ performance after their teaching sessions. It is important to address these gaps in knowledge within a teaching program and to find the most appropriate method to keep trainees knowledge and skills up-to-date.
1. Morris S, Stacey M. Resuscitation in pregnancy. BMJ 2003;327:1277-9.
2. Abbas AE, Lester SJ, Connolly H. Pregnancy and the cardiovascular system. Int J Cardiol 2005;98:179-89.
3. The American Heart Association Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Part 10.8: Cardiac arrest associated with pregnancy. Circulation 2005; 112: IV150-3.
4. Fletcher G, Flin R, McGeorge P, Glavin R, et al. Anaesthetists' Non-Technical Skills (ANTS): Evaluation of a behavioural marker system. Br J Anaes 2003; 90 (5): 580-8.