title: Transport decreases the quality of cardiopulmonary resuscitation during simulated maternal cardiac arrest.
abstract: BACKGROUND
  The purpose of this study was to compare cardiopulmonary resuscitation (CPR) for simulated maternal cardiac arrest rendered during transport to the operating room with that rendered while stationary in the labor room. We hypothesized that the quality of CPR would deteriorate during transport.
  
  
  METHODS
  Twenty-six teams composed of 2 providers (obstetricians, nurses, or anesthesiologists) were randomized to perform CPR on the Laerdal Resusci Anne SkillReporter™ mannequin during transport or while stationary. The primary outcome measure was the percentage of correctly delivered compressions, defined as compression rate ≥100 beats per minute, correct sternal hand placement, compression depth ≥1.5 inches (3.8 cm), and proper release. Secondary outcomes included interruptions in compressions, position of providers relative to the mannequin during the transport phase, and ventilation tidal volume.
  
  
  RESULTS
  The median (interquartile range) percentage of correctly rendered compressions during phase II was 32% (10%-63%) in the transport group and 93% (58%-100%) in the stationary group (P = 0.002, 95% confidence interval of mean difference = 22%-58%). The median (interquartile range) compression rates were 124 (110-140) beats per minute in the transport group and 123 (115-132) beats per minute in the stationary group (P = 0.531). Interruptions in CPR were observed in 92% of transport and 7% of stationary drills (P < 0.001, 95% confidence interval of difference = 61%-92%). During transport, 18 providers kneeled next to the mannequin, 2 straddled the mannequin, and 4 ran alongside the gurney. Median (interquartile range) tidal volume was 270 (166-430) mL in the transport group and 390 (232-513) mL in the stationary group (P = 0.03).
  
  
  CONCLUSIONS
  Our data confirm our hypothesis and demonstrate that transport negatively affects the overall quality of resuscitation on a mannequin during simulated maternal arrest. These findings, together with previously published data on transport-related delays when moving from the labor room to the operating room further strengthen recommendations that perimortem cesarean delivery should be performed at the site of maternal cardiac arrest.
authors.affiliation: Department of Anesthesia, Stanford University, 300 Pasteur Dr., MC5640, Stanford, CA 94305, USA. steve.lipman@stanford.edu
authors.forename: Steven S
authors.initials: SS
authors.lastname: Lipman
authors.forename: Jocelyn Y
authors.initials: JY
authors.lastname: Wong
authors.forename: Julie
authors.initials: J
authors.lastname: Arafeh
authors.forename: Sheila E
authors.initials: SE
authors.lastname: Cohen
authors.forename: Brendan
authors.initials: B
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D016001:Confidence Intervals; D023381:Endpoint Determination; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008348:Manikins; D008875:Middle Aged; D010865:Pilot Projects; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D018401:Sample Size; D013990:Tidal Volume; D014187:Transportation of Patients; D016896:Treatment Outcome; D055815:Young Adult