Improving Knowledge and Confidence in the Resuscitation of the Peripartum Patient Through Simulation

ABSTRACT

Rationale Per the CDC, Since the COVID-19 pandemic, at least 25,000 pregnant women have been hospitalized in the USA, with almost 4% requiring ICU admission. Care of the critically ill pregnant patient is distinct and complex due to changes in physiology, cardiovascular demands, and changes in immune system function. Though cardiac arrest in a pregnant patient is fortunately rare, a poor outcome can be devastating. Existing literature suggests that providers have knowledge deficits regarding recommended resuscitation practices of parturients (Cohen). Additionally, in simulated scenarios, teams exhibit significant deficiencies when scored on Advanced Cardiac Life Support (ACLS) metrics when responding to a simulated pregnant patient in cardiopulmonary arrest (Lipman). We developed a high fidelity simulation in accordance with the 2020 American Heart Association (AHA) ACLS guidelines, with the hope that deliberate practice would improve response to future resuscitation efforts (Panchal). Methods Between October and December 2021, we recruited eighty-six Internal Medicine residents at a large university hospital program to complete knowledge (multiple choice) and confidence (Likert scale) assessment before and after participation in a maternal arrest simulation. For the knowledge assessment component, we utilized questions relating to the resuscitation of a pregnant patient previously published in the anesthesia literature (Cohen). Questions were derived from high yield practices highlighted in the 2020 AHA guidelines for ACLS in the peripartum patient. Data were compared using a two-tailed t-test with unequal variance. Results Regarding clinical knowledge, participants showed significant improvement in correct patient positioning (+34.5%, P = 0.00), epinephrine dosing (+10.53%, P = 0.01), and timing of perimortem delivery (+22.5%, P = 0.00). Participants also had significantly improved confidence in approaching peripartum scenarios (+53%, P = 0.00) and general ACLS scenarios (+63%, P = 0.00). Conclusions Following participation in our simulation, residents demonstrated increased confidence and increased medical knowledge related to the resuscitation algorithm utilized when caring for pregnant patients. In the future, we plan to survey residents to determine if this knowledge and confidence persists or decays over time. (Table Presented).