Department of Obstetrics and Gynecology, University of Connecticut, Farmington, CT, USA.
Department of Obstetrics and Gynecology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA.
BMC Emerg Med. 2022 Aug 26;22(1):149. doi: 10.1186/s12873-022-00704-7.
Maternal cardiac arrest is a rare and complex process requiring pregnancy-specific responses and techniques. The goals of this study were to (1) identify, evaluate, and determine the most current best practices to treat this patient population and (2) establish a standardized set of guidelines to serve as a foundation for a future educational simulation-based curriculum.
We used a three-step modified Delphi process to achieve consensus. Twenty-two healthcare experts from across North America agreed to participate in the expert panel. In round 1, 12 pregnancy-specific best practice statements were distributed to the expert panel. Panelists anonymously ranked these using a 7-point Likert scale and provided feedback. Round 2 consisted of a face-to-face consensus meeting where statements that had not already achieved consensus were discussed and then subsequently voted upon by the panelists.
Through two rounds, we achieved consensus on nine evidence-based pregnancy-specific techniques to optimize response to maternal cardiac arrest. Round one resulted in one of the 12 best practice statements achieving consensus. Round two resulted in six of the remaining 12 gaining consensus. Best practice techniques involved use of point-of care ultrasound, resuscitative cesarean delivery, cardiopulmonary resuscitation techniques, and the use of extracorporeal cardiopulmonary resuscitation.
The results of this study provide the foundation to develop an optimal, long-term strategy to treat cardiac arrest in pregnancy. We propose these nine priorities for standard practice, curricula, and guidelines to treat maternal cardiac arrest and hope they serve as a foundation for a future educational curriculum.
产妇心搏骤停是一种罕见且复杂的过程，需要针对妊娠的特殊反应和技术。本研究的目的是：(1)识别、评估和确定治疗该患者人群的最新最佳实践，以及(2)建立一套标准化指南，作为未来基于模拟教育课程的基础。
我们使用三步改良 Delphi 流程达成共识。来自北美的 22 名医疗保健专家同意参加专家小组。在第一轮中，向专家小组分发了 12 项针对妊娠的最佳实践声明。小组成员使用 7 分李克特量表匿名对这些声明进行排名，并提供反馈。第二轮由面对面的共识会议组成，讨论尚未达成共识的声明，然后由小组成员投票。
通过两轮，我们就九项基于证据的针对妊娠的特定技术达成共识，以优化对产妇心搏骤停的反应。第一轮有一项最佳实践声明达成共识。第二轮，其余 12 项中有 6 项达成共识。最佳实践技术涉及使用即时护理超声、复苏性剖宫产、心肺复苏技术以及体外心肺复苏的使用。
本研究的结果为制定治疗妊娠心搏骤停的最佳长期策略提供了基础。我们提出了这九个标准实践、课程和指南的优先级，以治疗产妇心搏骤停，并希望它们成为未来教育课程的基础。
