title: Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises.
abstract: OBJECTIVE
  Previous work suggests the potential for suboptimal cardiopulmonary resuscitation (CPR) in the parturient but did not directly assess actual performance.
  
  
  METHODS
  We evaluated 18 videotaped simulations of maternal amniotic fluid embolus and resultant cardiac arrest. A checklist containing 10 current American Heart Association recommendations for advanced cardiac life support (ACLS) in obstetric patients was utilized. We evaluated which tasks were completed correctly and the time required to perform key actions.
  
  
  RESULTS
  Proper compressions were delivered by our teams 56% of the time and ventilations 50% of the time. Critical interventions such as left uterine displacement and placing a firm back support prior to compressions were frequently neglected (in 44% and 22% of cases, respectively). The mean +/- SD overall composite score for the tasks was 45 +/- 12% (range, 20-60%). The neonatal team was called in a median (interquartile range) of 1:42 (0:44-2:18) minutes:seconds; 15 of 18 (83%) teams called only after the patient was completely unresponsive. Fifty percent of teams did not provide basic information to the neonatal teams as required by neonatal resuscitation provider guidelines.
  
  
  CONCLUSIONS
  Multiple deficits were noted in the provision of CPR to parturients during simulated arrests, despite current ACLS certification for all participants. Current requirements for ACLS certification and training for obstetric staff may require revision.
authors.affiliation: Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 9430, USA. steve.lipman@stanford.edu
authors.forename: Steven S
authors.initials: SS
authors.lastname: Lipman
authors.forename: Kay I
authors.initials: KI
authors.lastname: Daniels
authors.forename: Brendan
authors.initials: B
authors.lastname: Carvalho
authors.forename: Julie
authors.initials: J
authors.lastname: Arafeh
authors.forename: Kimberly
authors.initials: K
authors.lastname: Harney
authors.forename: Andrea
authors.initials: A
authors.lastname: Puck
authors.forename: Sheila E
authors.initials: SE
authors.lastname: Cohen
authors.forename: Maurice
authors.initials: M
authors.lastname: Druzin
mesh_terms: D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods*; D002983:Clinical Competence; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D004619:Embolism, Amniotic Fluid / Q000401:mortality / Q000628:therapy; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D017145:Models, Educational; D020380:Needs Assessment; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010348:Patient Care Team; D016544:Patient Simulation; D011247:Pregnancy; D011336:Probability; D014481:United States