Cardiac arrest in the pregnant patient - Using simulation to improve internal medicine resident competency.

BACKGROUND

While cardiac arrest during pregnancy is uncommon, its consequences can be severe and life-threatening. Existing literature suggests that providers have knowledge gaps regarding resuscitation in peripartum patients. Simulation has been used to train obstetrics nurses and other trainees in Advanced Cardiac Life Support (ACLS). However, training curricula designed for providers with little formal obstetric resuscitation experience is lacking.

AIMS

To improve internal medicine residents' knowledge and confidence related to the resuscitation of pregnant patients.

METHODS

This was a one-group pre-test, immediate post-test, delayed post-test observational study. Prior to the simulation, residents completed a survey assessing their confidence managing pregnant patients as well as knowledge related to ACLS in pregnancy. Each team then participated in a 30-min simulation, received immediate feedback on their performance, and completed an immediate post-simulation knowledge assessment measure. Residents who agreed to participate in the study then completed a delayed post-simulation knowledge and confidence assessment survey three months following the training session.

RESULTS

Eighty-six residents participated in the research study. Immediately after completing the simulation, participants exhibited significant improvements in knowledge related to uterine positioning (+34%), epinephrine dosing (+11%), and timing of perimortem delivery (+22%). Participants also reported increased confidence with managing cardiac arrest in pregnant patients and satisfaction with the simulation. Knowledge and confidence improvements were sustained at the three-month follow-up.

CONCLUSION

High fidelity simulation can be used to train internal medicine residents to manage cardiac arrest in pregnancy. Simulation training is associated with sustained improvements in medical knowledge and confidence related to peripartum resuscitation.