From the Departments of Anesthesia and Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California.
Obstet Gynecol. 2011 Nov;118(5):1090-1094. doi: 10.1097/AOG.0b013e3182319a08.
To compare the labor room and operating room for perimortem cesarean delivery during simulated maternal arrests occurring outside the operating room. We hypothesized transport to the operating room for perimortem cesarean delivery would delay incision and other important resuscitation milestones.
We randomized 15 teams composed of obstetricians, nurses, anesthesiologists, and neonatal staff to perform perimortem cesarean delivery in the labor room or operating room. A manikin with an abdominal model overlay was used for simulated cesarean delivery. The scenario began in the labor room with maternal cardiopulmonary arrest and fetal bradycardia. The primary outcome was time to incision. Secondary outcomes included times to important milestones, percentage of tasks completed, and type of incision.
The median (interquartile range) times from time zero to incision were 4:25 (3:59-4:50) and 7:53 (7:18-8:57) minutes in the labor room and operating room groups, respectively (P=.004). Fifty-seven percent of labor room teams and 14% of operating room teams achieved delivery within 5 minutes. Contacting the neonatal team, placing the defibrillator, resuming compressions after analysis, and endotracheal intubation all occurred more rapidly in the labor room group.
Perimortem cesarean delivery performed in the labor room was significantly faster than perimortem cesarean delivery performed after moving to the operating room. Delivery within 5 minutes was challenging in either location despite optimal study conditions (eg, the manikin was light and easily moved; teams knew the scenario mandated perimortem cesarean delivery and were aware of being timed). Our findings imply that perimortem cesarean delivery during actual arrest would require more than 5 minutes and should be performed in the labor room rather than relocating to the operating room.
比较在手术室外模拟产妇心跳骤停时在产房和手术室进行产房急救剖宫产的情况。我们假设将产妇转运至手术室进行产房急救剖宫产会延迟切口的切开和其他重要的复苏里程碑事件的发生。
我们将由产科医生、护士、麻醉师和新生儿工作人员组成的 15 个团队随机分配到产房或手术室进行产房急救剖宫产。使用带有腹部模型覆盖物的模拟人进行模拟剖宫产。该场景从产房开始，产妇发生心肺骤停和胎儿心动过缓。主要结局是切开切口的时间。次要结局包括重要里程碑的时间、任务完成百分比和切口类型。
从时间零到切口的中位数（四分位距）分别为产房组 4:25（3:59-4:50）和手术室组 7:53（7:18-8:57）分钟（P<.004）。产房组 57%的团队和手术室组 14%的团队在 5 分钟内完成分娩。在产房组，联系新生儿团队、放置除颤器、在分析后恢复按压以及进行气管插管等操作都更快。
在产房进行的产房急救剖宫产明显快于转移至手术室后的剖宫产。尽管在最佳研究条件下（例如，模拟人很轻且易于移动；团队知道该场景需要进行产房急救剖宫产，并且知道正在计时），在任何一个位置都很难在 5 分钟内完成分娩。我们的研究结果表明，在实际心跳骤停期间进行产房急救剖宫产可能需要超过 5 分钟，并且应该在产房进行，而不是转移到手术室。
