Improved maternal cardiac arrest management reported from Obstetric Life Support training

Improved maternal cardiac arrest management reported from Obstetric Life Support training | Image Credit: © Mediteraneo - © Mediteraneo - stock.adobe.com.

Management of maternal cardiac arrest (MCA) among health care providers is significantly improved by Obstetric Life Support (OBLS) education, according to a recent study published in JAMA Network Open.¹

MCA occurs in 1 in 3885 patients admitted for delivery, with evidence-based practices recommended for management by the American Heart Association. In the United States, there are currently no specific training requirements for MCA despite the country having a significant maternal mortality rate of 22.3 per 100,000 live births.²

While the current survival rate for MCA is estimated at 16%, this rate can be significantly improved by optimizing the chain of survival.¹ Therefore, it may be vital to reduce gaps in provider knowledge and skills related to MCA. OBLS is a training program designed to provide health care professionals with these skills.

To evaluate the impact of OBLS toward efficacy of MCA management among health care professionals, investigators conducted a randomized clinical trial. Research coordinators performed data collection while data analyses were conducted by a biostatistician.

English-speaking health care professionals aged over 18 years working with reproductive-aged women in a prehospital or in-hospital environment were eligible for inclusion. Prehospital OHS education included a maximum of 4 participants per class across 2 crews, while hospital OHS education included a maximum of 6 participants.

Participants were assigned 1:1 to receive either OHS education or no education, with randomization stratified by hospital status. Cognitive and confidence evaluations were performed at enrollment for individuals in the OHS arm, alongside additional evaluations after intervention time, 6 months after enrollment, and 12 months after enrollment.

In the control group, participants received evaluations at enrollment and at 6 months after enrollment. Then, a third evaluation occurred after another 6 months following intervention.

The OBLS was defined as a “comprehensive, interdisciplinary, simulation-based training curriculum on MCA prevention and treatment based on the accepted evidence-based guidelines from the American Heart Association.” Participants needed an evaluation score of 70% or higher to pass.

Demographic and baseline data was collected. The cognitive score at time 1, defined as enrollment for controls and after the intervention for cases, was reported as the primary outcome. Megacode scores during time 1 were also a primary outcome. Additional evaluation scores were reported as secondary outcomes.

There were 46 participants aged a mean 41.1 years included in the analysis. Of participants, 7% were Asian, 7% Black, 2% Hispanic, 58% White, and 2% other. Experience as a simulation instructor was reported by only 37%.

Aside from 2 participants in the control group being certified in Advanced Trauma Life Support vs 0 in the intervention group, similar baseline characteristics were reported between groups. This included experience as a simulation, advanced cardiac life support, or Basic Life Support instructor.

The intervention group had a higher mean cognitive score compared to the control group, at 79.5% vs 63.4%, respectively. Similarly, megacode scores were 91% vs 61%, respectively, indicating a significant increase among patients receiving the intervention.

Finally, assessment pass rates were 90% and 10%, respectively, and mean confidence scores were 13.3 and 17.9 points, respectively. In the control group, confidence scores increased after OBLS education and at 6 months, at 24.3 and 20.6 points, respectively.

These results indicated improved readiness among health care professionals for managing MCA following an OBLS program intervention. Investigators concluded broader implementation of resuscitation training is necessary to prepare health care professionals for maternal medical emergencies.

Reference

1. Shields AD, Vidosh J, Minard C, et al. Obstetric Life Support education for maternal cardiac arrest: A randomized clinical trial. JAMA Netw Open. 2024;7(11):e2445295. doi:10.1001/jamanetworkopen.2024.45295
2. HoyertDL. Health E-stat: maternal mortality rates in the United States, 2022. National Center for Health Statistics. 2024. doi:10.15620/cdc/152992