• Steven S Lipman, Kay I Daniels, Brendan Carvalho, Julie Arafeh, Kimberly Harney, Andrea Puck, Sheila E Cohen, and Maurice Druzin.
• Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 9430, USA. steve.lipman@stanford.edu
• Am. J. Obstet. Gynecol. 2010 Aug 1;203(2):179.e1-5.

ObjectivePrevious work suggests the potential for suboptimal cardiopulmonary resuscitation (CPR) in the parturient but did not directly assess actual performance.Study DesignWe evaluated 18 videotaped simulations of maternal amniotic fluid embolus and resultant cardiac arrest. A checklist containing 10 current American Heart Association recommendations for advanced cardiac life support (ACLS) in obstetric patients was utilized. We evaluated which tasks were completed correctly and the time required to perform key actions.ResultsProper compressions were delivered by our teams 56% of the time and ventilations 50% of the time. Critical interventions such as left uterine displacement and placing a firm back support prior to compressions were frequently neglected (in 44% and 22% of cases, respectively). The mean +/- SD overall composite score for the tasks was 45 +/- 12% (range, 20-60%). The neonatal team was called in a median (interquartile range) of 1:42 (0:44-2:18) minutes:seconds; 15 of 18 (83%) teams called only after the patient was completely unresponsive. Fifty percent of teams did not provide basic information to the neonatal teams as required by neonatal resuscitation provider guidelines.ConclusionMultiple deficits were noted in the provision of CPR to parturients during simulated arrests, despite current ACLS certification for all participants. Current requirements for ACLS certification and training for obstetric staff may require revision.Copyright (c) 2010 Mosby, Inc. All rights reserved.

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