Critical Care Research and Practice

Research Article

Management of Maternal Cardiac Arrest in the Third Trimester of Pregnancy: A Simulation-Based Pilot Study

Table 2

Residents team competence scores (paired) before and after intervention.


Critical performance steps (area of competency/posttest competency)		Pretest competency
		Not competent	Competent	value

Team leader
Ensures high-quality CPR at all times	Not Competent	9 (100%)		NA
Ensures high-quality CPR at all times	Competent
Assigns team member roles	Not Competent	9 (100%)		NA
Assigns team member roles	Competent
Ensures that team members perform well	Not Competent	5 (55.6%)		0.134
Ensures that team members perform well	Competent	4 (44.4%)

VF management
Recognizes VF	Not Competent	5 (55.6%)		0.134
Recognizes VF	Competent	4 (44.4%)
Clears before ANALYZE and SHOCK	Not Competent			NA
Clears before ANALYZE and SHOCK	Competent		9 (100%)
Immediately resumes CPR after shocks	Not Competent			NA
Immediately resumes CPR after shocks	Competent		9 (100%)
Appropriate airway management	Not Competent			0.008
Appropriate airway management	Competent	9 (100%)
Appropriate cycles of drug-rhythm check/shock-CPR	Not Competent			0.008
Appropriate cycles of drug-rhythm check/shock-CPR	Competent	9 (100%)
Administer appropriate drug(s) and doses	Not Competent	9 (100%)		NA
Administer appropriate drug(s) and doses	Competent

BLS/ACLS modifications for pregnancy
Activates protocol for an emergency cesarean delivery as soon as cardiac ⁢arrest is identified	Not Competent			0.134
	Competent	4 (44.4%)	5 (55.6%)
Positions patient in left-lateral tilt or performs manual uterine displacement	Not Competent			0.008
	Competent	9 (100%)
Performs chest compressions slightly higher on sternum than normally ⁢recommended	Not Competent			0.074
	Competent	5 (55.6%)	4 (44.4%)
Uses bag-mask ventilation with 100% O₂ before intubation is done	Not Competent			0.074
	Competent	5 (55.6%)	4 (44.4%)
Attempts to identify common and reversible causes of cardiac arrest in ⁢pregnancy	Not Competent			0.008
	Competent	9 (100%)
Delivers infant by emergency cesarean section	Not Competent			NA
Delivers infant by emergency cesarean section	Competent		9 (100%)
Delivers infant no more than 5 minutes after cardiac arrest ensues	Not Competent			0.074
	Competent	5 (55.6%)	4 (44.4%)

Postcardiac arrest
Identifies ROSC	Not Competent			0.074
Identifies ROSC	Competent	5 (55.6%)	4 (44.4%)
Ensures BP and 12 lead ECG are performed and O₂ saturation is monitored, ⁢verbalizes need for endotracheal intubation and waveform capnography, ⁢and orders laboratory test	Not Competent	9 (100%)		NA
	Competent
Considers therapeutic hypothermia	Not Competent	9 (100%)		NA
Considers therapeutic hypothermia	Competent

Note: value via McNemar’s test. Competency is defined by a majority of rater’s competency determination.