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Simulations Raise Concerns about Managing Cardiac Arrest in Pregnant Patients

November 5, 2012 11:00 AM

Anesthesia Residents Show 'Poor Knowledge' of Handling Rare Obstetric Crises

Newswise — San Francisco, CA. (November 5, 2012) – Anesthesiology residents may not be prepared to manage rare but life-threatening emergencies involving cardiac arrest during labor and delivery, suggests a stimulation study in the November issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

In simulations, many residents don't follow recommended steps for resuscitation of pregnant women during "obstetric crises," according to the study led by Dr Haim Berkenstadt of Sheba Medical Center, Tel Hashomer, Israel. The researchers write, "Our findings suggest a serious failure in learning maternal resuscitation and suggest a unique role for simulation in both assessment and educational quality assurance."

Residents Omit Key Steps in Resuscitation of Patient in Labor
In the study, 25 Israeli senior anesthesiology residents were evaluated for performance in a simulated obstetric crisis—a pregnant woman in labor with complications leading to cardiac arrest. Based on an actual patient case, the simulation was performed using a lifelike, computerized medical mannequin.

The residents' performance in carrying out the correct steps for general resuscitation was evaluated, along with steps specific to resuscitation of pregnant women in labor. After the simulation, the residents were interviewed in a "debriefing" session to discuss their performance.

The residents did well on the general resuscitation steps, such as starting chest compressions, providing ventilation, and performing electrical defibrillation. All of these steps were correctly performed by over 90 percent of residents.

However, performance on steps specific to resuscitation in pregnancy was not as good. For example, only 68 percent of residents moved the simulated "patient" into the recommended position (on the left side, to take pressure from the uterus off the major blood vessels). Only 40 percent prepared to perform emergency cesarean section to deliver the infant in case the mother died.

In contrast, during the debriefing session, most of the residents correctly described the proper steps to take in resuscitation of a patient in labor. Notably, 80 percent correctly described the steps to prepare for emergency delivery of the infant—even though most failed to perform these steps during the simulation.

Cardiac arrest during labor is a rare but often fatal event. "Appropriate resuscitation in this special situation may save the lives of the mother and/or unborn baby," Dr Berkenstadt and colleagues explain. There are concerns about a possible increase in the rate of pregnancy-related deaths. Surveys have suggested that anesthesiologists and obstetricians who treat pregnancy on a daily basis have limited knowledge of the recommendations for treating maternal cardiac arrest.

In this Israeli study, "Senior anesthesiology residents have poor knowledge of resuscitation of the pregnant patient," Dr Berkenstadt and coauthors write. Although residents demonstrate general resuscitation steps, many fail to properly perform steps specific to pregnancy. Improving maternal resuscitation skills is an important target for efforts to reduce the rate of pregnancy-related deaths.

Dr Berkenstadt and colleagues believe that the two-stage process used in their study—simulation followed by debriefing—"allows for a more efficient simulation-based assessment." Such assessments may be especially valuable in demonstrating gaps between what residents know and their ability to carry out the recommended steps in a clinical situation. Simulations can play "a unique role…in both assessment and education quality assurance," the researchers conclude.

Read the article in Anesthesia & Analgesia

About the IARS
The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more than 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia related practice; sponsors the SmartTots initiative in partnership with the FDA; and publishes the monthly journal Anesthesia & Analgesia in print and online.

About Anesthesia & Analgesia
Anesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.