title: Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study.
abstract: Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9 ± 8.9 versus post: 72.8 ± 6.1, p = 0.01) and CS total scores (pre: 22.2 ± 6.4 versus post: 29.9 ± 3.4, p = 0.007). Significant differences were noted in airway management, p = 0.008; appropriate cycles of drug/shock-CPR, p = 0.008; left uterine displacement, p = 0.008; and identifying causes of cardiac arrest, p = 0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p = 0.074; chest compressions, p = 0.074; bag-mask ventilation before intubation, p = 0.074; and return of spontaneous circulation identification, p = 0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency.
authors.affiliation: Summa Health System, Department of Obstetrics and Gynecology, Akron, OH 44304, USA.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Adams
authors.affiliation: Summa Health System, Department of Medical Education, Virtual Care Medical Simulation Laboratory, Akron, OH 44304, USA.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Cepeda Brito
authors.affiliation: Summa Health System, Department of Obstetrics and Gynecology, Akron, OH 44304, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Baker
authors.affiliation: Summa Health System, Department of Medical Education, Virtual Care Medical Simulation Laboratory, Akron, OH 44304, USA.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Hughes
authors.affiliation: Biostats Inc., Canton, OH 44730, USA.
authors.forename: M David
authors.initials: MD
authors.lastname: Gothard
authors.affiliation: Summa Health System, Summa Center for Women's Health Research, Akron, OH 44304, USA.
authors.forename: Michele L
authors.identifier: 0000-0003-0950-8882
authors.initials: ML
authors.lastname: McCarroll
authors.affiliation: Summa Health System, Department of Nursing Professional Development, Akron, OH 44304, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Davis
authors.affiliation: Summa Health System, Department of Obstetrics and Gynecology and Department of Maternal Fetal Medicine, Akron, OH 44304, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Silber
authors.affiliation: Summa Health System, Department of Medical Education, Virtual Care Medical Simulation Laboratory, Akron, OH 44304, USA.
authors.forename: Rami A
authors.identifier: 0000-0001-8518-6083
authors.initials: RA
authors.lastname: Ahmed