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Multidisciplinary Team Performance During Simulated Local Anesthetic Systemic Toxicity and Maternal Cardiac Arrest: A Prospective Observational Study
Abstract Number: T-57
Abstract Type: Original Research
Introduction: Maternal cardiac arrest (MCA) from local anesthetic systemic toxicity (LAST) is a rare but potentially devastating event. Individual performance during simulation of non-obstetric LAST has been studied, but data is limited on obstetric team performance. This study aimed to measure time to critical resuscitation tasks during multidisciplinary team-based simulation of LAST and MCA.
Methods: Anesthesia residents and fellows, nurses, OR staff, and obstetric attendings, fellows and residents participated in this ongoing IRB-exempt, prospective observational study. An in situ, high-fidelity manikin simulated a 35 year old G1PO (65kg) who developed central nervous system and cardiovascular instability followed by asystole after receiving bupivacaine (12ml/hr of 0.0625% and 3x5ml of 0.25%) for labor analgesia and 20-25 ml of 2% lidocaine with epinephrine 1:200,000 for cesarean. We measured time to: announcement of obstetric code; initiation of advanced cardiac life support; manual uterine displacement; diagnosis of LAST; administration of lipid emulsion rescue and delivery of the fetus. Participants signed audiovisual consent and recordings were used to verify data. Sessions included an educational didactic presentation, debrief, and survey.
Results: To date, 7 multidisciplinary teams have participated. The Table shows times to critical resuscitation tasks. All teams called an obstetric code, performed chest compressions, and delivered the fetus, but no teams performed manual uterine displacement. Nurses, obstetric providers, and operating room staff in every session reported that the simulation, didactic, and debrief transformed their knowledge of LAST from limited to good or excellent.
Discussion: Multidisciplinary teams in this simulation study performed in accordance with the American Heart Association Guidelines and the Society for Obstetric Anesthesia and Perinatology Consensus Statement on Cardiac Arrest Management in Pregnancy.[3,4] Despite knowledge gaps among non-anesthesia providers, all teams diagnosed and treated LAST in accordance with the American Society of Regional Anesthesia practice advisory. Teams did not perform manual uterine displacement, suggesting more education is required to optimize maternal and fetal resuscitation and improve outcomes.
1)Int J Obstet Anesth 2011;20:60-3
2)Reg Anesth Pain Med 2012;37:8-15
4)Anesth Analg 2014;118:1003–16
5)Reg Anesth Pain Med 2010;35:1