Critical Delays in Cardiopulmonary Resuscitation During Simulated Obstetric Crisis: a Prospective Observational Study.

NCT04050631 | Unknown

• 1 other identifier: REB19-0042
• Study Type: observational
• Target: 120
• Locations: 1 country
• Sites: 1

Brief Summary

Maternal cardiac arrest is underreported and continues to occur at rate of 1:20,000 pregnancies. Despite being predominantly younger patients, survival rates among pregnant women are poor with one case series reporting a survival rate of 6.9%. Resuscitation of a pregnant women can be challenging when compared to non-pregnant adults. Aggressive maneuvers (perimortum cesarean section) and multidisciplinary team efforts are required because of the anatomical and physiological changes associated with pregnancy, in addition to taking care of two patents (mother and fetus). The first 5 minutes from the onset of cardiac arrest are the most crucial in terms of neonatal survival. In maternal deaths involving acute cardiac arrest, advanced cardiac life support (ACLS) must be rapidly administered. Previous work suggests deficits in cardiac arrest care during maternal cardiac arrest. The current literature fails to adequately quantify the severity, timing and frequency of errors made during maternal cardiac arrest care amongst interprofessional healthcare teams. The primary goal of this study is to characterize the quality of actions by first responders during simulated in-hospital maternal medical emergencies. Specific objectives are:

1. 1.to examine critical delays by measuring the median duration of the interval between when a resuscitation maneuver was indicated and when it was initiated by first responders ( nursing staff at L\&D attending the patient).
2. 2.to describe the type and frequency of resuscitation errors identified as deviations from AHA guidelines during obstetric cardiac arrest. By addressing this gap in the literature, we hope to highlight areas of future education and/or innovation aimed at improving performance during maternal cardiac arrest care.

Conditions

Maternal Death During Childbirth

Outcome Measures

Primary Outcomes (4)

• The primary outcomes will be the median duration of the interval between when a resuscitation maneuver is indicated and when it will be initiated by first responders.

  oxygenation

  10/ minutes

• The primary outcomes will be the median duration of the interval between when a resuscitation maneuver is indicated and when it will be initiated by first responders.

  chest compressions

  100-120/minutes

• The primary outcomes will be the median duration of the interval between when a resuscitation maneuver is indicated and when it will be initiated by first responders.

  defibrillation

  minutes

• The primary outcomes will be the median duration of the interval between when a resuscitation maneuver is indicated and when it will be initiated by first responders.

  time to incision

  5 minutes

Secondary Outcomes (2)

• Quality of CPR

  15 mins

• Quality of CPR

  15 minutes

Study Arms (1)

L&D team

the first responders on L\&D floor including : anesthesia, nurses and OBGYN

Behavioral: maternal arrest simulation on L&D floor

Interventions

maternal arrest simulation on L&D floor BEHAVIORAL

AFE on L\&D

L&D team

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Health care providers at L\&D floor : Anesthesia, OBGYN, Nurses

You may qualify if:

• Obstetric healthcare providers: including: nurses, nurse practitioners, respiratory therapists and residents (obstetric and anesthesia)
• Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification within the past two years;

You may not qualify if:

• Not BLS certified.
• Participant refusal

Sponsors & Collaborators

• KidSIM Simulation Program: lead

Study Sites (1)

Foothills Medical Center

Calgary, Alberta, Canada

RECRUITING

Related Publications (3)

• Campbell TA, Sanson TG. Cardiac arrest and pregnancy. J Emerg Trauma Shock. 2009 Jan;2(1):34-42. doi: 10.4103/0974-2700.43586.

  PMID: 19561954 BACKGROUND

• Dijkman A, Huisman CM, Smit M, Schutte JM, Zwart JJ, van Roosmalen JJ, Oepkes D. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG. 2010 Feb;117(3):282-7. doi: 10.1111/j.1471-0528.2009.02461.x.

  PMID: 20078586 BACKGROUND

• Yeomans ER, Gilstrap LC 3rd. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med. 2005 Oct;33(10 Suppl):S256-8. doi: 10.1097/01.ccm.0000183540.69405.90.

  PMID: 16215345 BACKGROUND

Study Officials

• Adam Cheng

  University of Calgary

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Fatemah Qasem

CONTACT

40395524332; fatema.qasem@ucalgary.ca

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: NETWORK
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 30, 2019
• First Posted: August 8, 2019
• Study Start: January 5, 2020
• Primary Completion: May 30, 2020
• Study Completion: May 30, 2020
• Last Updated: March 24, 2020

Record last verified: 2020-03

Locations

CA (1)