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Transport from the Labor Room to the Operating Room Significantly Decreases the Quality of CPR During Simulated Maternal Cardiac Arrest
Abstract Number: OP1-2
Abstract Type: Original Research
Introduction: This simulation study compared cardiopulmonary resuscitation (CPR) rendered during transport to the operating room (OR) versus that rendered while stationary in the labor room (LR). We hypothesized that transport would decrease the quality of CPR, an outcome that would impact patient transport to the OR for perimortem cesarean delivery (1).
Methods: This randomized, prospective study was conducted at Lucile Packard Children’s Hospital, Stanford, California. Twenty-six teams composed of two staff persons (obstetricians, nurses, anesthesiologists) were randomized to perform CPR on the Laerdal Skills Reporter mannequin during transport or while stationary. Each drill was comprised of three continuous phases: 4 min while stationary, 2 min randomized to either remaining stationary or to transport, and 4 min while stationary. During transport, two individuals not participating as study subjects moved the gurney from the LR to the OR while the study team performed CPR. The primary outcome was the percentage of correctly delivered compressions based on rate>100, sternal hand placement, depth > 1.5 inches and release. Secondary outcomes included ventilation tidal volume, interruptions in compressions, and position of staff relative to the mannequin during the transport phase.
Results: The percentage of correct compressions was 32% in the transport group and 93% in the stationary group (Figure; P < 0.001). The median (IQR) compression rates were 124 (110-140) per minute in the transport group and 123 (115-132) in the stationary group (P = 0.703). The percent of compressions of insufficient depth was 21% in the transport group and <1% in the stationary group (P < 0.001). Interruptions in CPR were observed in 92% of transport and 8% of stationary drills (P<0.001). Median (IQR) tidal volume was 270 (166-430) mL in the transport group and 390 (232-513) mL in the stationary group (P=0.031). During transport, 2 staff straddled the mannequin, 18 kneeled next to the mannequin, and 4 ran alongside the gurney.
Conclusion: Our data demonstrates that transport negatively impacts the overall quality of resuscitation on a mannequin during simulated maternal arrests. These findings, together with previously published simulation data on patient transport-related delays in delivery via perimortem cesarean delivery (2), further strengthen recommendations that perimortem cesareans should be performed at the site of arrest.
1. Circulation 2010;122:S833-38.