MATERNAL CARDIAC ARREST AND THE USE OF MODIFIED ADVANCED CARDIAC LIFE SUPPORT: A CASE FROM MERCY STIMULATION TRAINING LAB

Abstract

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Amniotic fluid embolism (AFE) is one of the dreaded causes for cardiac arrest in pregnancy; a catastrophic complication which affects 1.9 to 6.1 women per 100,000 deliveries. Cardiac arrest in pregnancy is complicated and requires modified advanced cardiac life support (ACLS) and a multidisciplinary team approach. Literature suggests clinical simulation sessions increase confidence among physicians regarding their ability to manage maternal cardiac arrest in practice. The following case exemplifies the effectiveness of Mercy's weekly simulation training lab and mock code blues in preparing residents to respond to uncommon ACLS scenarios. CASE PRESENTATION: A 31 year old woman presented to the operating room for a planned low transverse cesarean section. Upon presentation the patient was asymptomatic and vital signs were stable. Immediately after delivery of the fetus, the patient suddenly became pulseless, hypotensive and bradycardic. Cardiopulmonary resuscitation was immediately initiated and a code blue was called. Laboratory data showed acute acidosis and acute thrombocytopenia. Patient met the diagnostic criteria of amniotic fluid embolism and the diagnosis was confirmed during resuscitation (Figure 1). CPR course is illustrated in (Figure 2). Bedside transthoracic echocardiogram showed a large highly mobile embolus in the right atrium. A shared decision was made to transfer the patient to a tertiary care center after return of spontaneous circulation was achieved. DISCUSSION: Maternal cardiac arrest is a complex catastrophic clinical scenario which requires a multidisciplinary team familiar with and confident in using modified ACLS algorithms. The Mercy Weekly Simulation Training curriculum included 7 AFE mock code blues that prepared 60 internal medicine (IM) residents to address the knowledge gaps and ensure proficiency in providing advanced cardiac life support. In this case, 5 IM residents responded to the code under the supervision of obstetricians, intensivists, cardiologists and anesthesiologists. Previous studies displayed that simulation sessions increase confidence among physicians regarding the ability to appropriately manage maternal cardiac arrest in clinical practice.Mercy's Weekly Simulation Training Lab ensured adequate training among all residents regarding advanced cardiac life support (ACLS) in pregnancy prior to this event. During this code our residents demonstrated high quality care and knowledge addressing maternal modified ACLS which resulted in a positive outcome. CONCLUSIONS: This case highlights the importance of simulation training sessions; through simulation training our team reinforced resuscitation skills further increasing resident confidence while concomitantly improving patient outcomes. Reference #1: Barsuk JH, Willams MC, Wayne DB, et al. Telling the whole story about simulation-based education. Obstet Gynecol. 2017; 96: 1273–1273. Reference #2: Lee A, Sheen JJ, Richards S. Intrapartum Maternal Cardiac Arrest: A Simulation Case for Multidisciplinary Providers. MedEdPORTAL. 2018;14:10768. Published 2018 Oct 2 Reference #3: Vaden Hoek TL, Morrison, LJ, Sguster M, Et al. Cardiac Arrest In Special Situations. AHA. 2010 10 Nov 2;122(18 Suppl 3):S829-61. DISCLOSURES: No relevant relationships by Andrew Ajemian, source=Web Response No relevant relationships by Waddah Malas, source=Web Response No relevant relationships by Michael Markos, source=Web Response No relevant relationships by Payman Sattar, source=Web Response No relevant relationships by Michael Thompson, source=Web Response