ABSTRACT
This is the first scientific statement from the American Heart Association on maternal resuscitation. This document will provide readers with up-to-date and comprehensive information, guidelines, and recommendations for all aspects of maternal resuscitation. Maternal resuscitation is an acute event that involves many subspecialties and allied health providers; this document will be relevant to all healthcare providers who are involved in resuscitation and specifically maternal resuscitation.
Subject(s)
Cardiopulmonary Resuscitation/methods , Emergency Medical Services/methods , Heart Arrest/therapy , Pregnancy Complications, Cardiovascular/therapy , Airway Management/methods , Cardiopulmonary Resuscitation/education , Cardiopulmonary Resuscitation/standards , Cardiovascular Agents/adverse effects , Cardiovascular Agents/therapeutic use , Critical Care/legislation & jurisprudence , Critical Care/methods , Critical Care/standards , Early Medical Intervention , Electric Countershock/methods , Emergency Medical Services/legislation & jurisprudence , Emergency Medical Services/standards , Female , Fetal Death/etiology , Fetal Death/prevention & control , Heart Arrest/physiopathology , Humans , Hypotension/etiology , Hypoxia/etiology , Hypoxia/prevention & control , Infant, Newborn , Oxygen Inhalation Therapy , Patient Positioning/methods , Patient Positioning/standards , Pregnancy , Pregnancy Complications, Cardiovascular/physiopathologyABSTRACT
OBJECTIVE: To compare the labor room and operating room for perimortem cesarean delivery during simulated maternal arrests occurring outside the operating room. We hypothesized transport to the operating room for perimortem cesarean delivery would delay incision and other important resuscitation milestones. METHODS: We randomized 15 teams composed of obstetricians, nurses, anesthesiologists, and neonatal staff to perform perimortem cesarean delivery in the labor room or operating room. A manikin with an abdominal model overlay was used for simulated cesarean delivery. The scenario began in the labor room with maternal cardiopulmonary arrest and fetal bradycardia. The primary outcome was time to incision. Secondary outcomes included times to important milestones, percentage of tasks completed, and type of incision. RESULTS: The median (interquartile range) times from time zero to incision were 4:25 (3:59-4:50) and 7:53 (7:18-8:57) minutes in the labor room and operating room groups, respectively (P=.004). Fifty-seven percent of labor room teams and 14% of operating room teams achieved delivery within 5 minutes. Contacting the neonatal team, placing the defibrillator, resuming compressions after analysis, and endotracheal intubation all occurred more rapidly in the labor room group. CONCLUSION: Perimortem cesarean delivery performed in the labor room was significantly faster than perimortem cesarean delivery performed after moving to the operating room. Delivery within 5 minutes was challenging in either location despite optimal study conditions (eg, the manikin was light and easily moved; teams knew the scenario mandated perimortem cesarean delivery and were aware of being timed). Our findings imply that perimortem cesarean delivery during actual arrest would require more than 5 minutes and should be performed in the labor room rather than relocating to the operating room.
