Labor room setting compared with the operating room for simulated perimortem cesarean delivery: a randomized controlled trial.
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.


CONCLUSIONS
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.
From the Departments of Anesthesia and Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California.
Steve
S
Lipman
Kay
K
Daniels
Sheila E
SE
Cohen
Brendan
B
Carvalho
D000328:Adult; D002585:Cesarean Section / Q000592:standards*; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000601:surgery*; D006801:Humans; D009873:Operating Rooms / Q000706:statistics & numerical data*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*; D013997:Time Factors