Obstetric Life Support Manual

Description:

This text is a comprehensive review in normal and abnormal pregnancy physiology, the most common etiologies of maternal medical emergencies, recognition of maternal deterioration and pending cardiopulmonary arrest, modifications to cardiopulmonary resuscitation in pregnant and postpartum patients, special procedures that can assist in diagnosing and treating maternal medical emergencies tailored to the setting (e.g., point-of-care ultrasound, resuscitative cesarean delivery, extracorporeal cardiopulmonary resuscitation), treatment of trauma/stroke in pregnancy, and postpartum maternal medical emergencies. There are streamlined algorithms and cognitive aids designed to improve a team’s ability to successfully implement techniques unique to treating maternal medical emergencies and cardiac arrest.

*Offers a practical guide to treating complex and challenging maternal medical emergencies
*Equips the entire team responding to a maternal cardiac arrest with the current evidence-based approaches and techniques
*Presents a thorough review, detailed algorithms, and a consolidated discussion of the practical aspects of implementation

Obstetric Life Support Course Overview

0.1 COURSE DESCRIPTION

The Obstetric Life Support (OBLS) course has been created for all healthcare providers who may encounter and participate in the management of maternal cardiopulmonary arrest or similar emergencies. Such personnel range from obstetricians and gynecologists (OB/GYNs), to emergency department (ED) providers, critical care providers, nurses, midwives, anesthesia providers, and all levels of emergency medical services (EMS) providers.

There are two broad areas of applicability of the OBLS course: in-hospital (IH) and out-of-hospital (OH). The IH applies to providers who care for pregnant people in clinics, urgent care and ED settings, and inpatient wards. The OH applies to EMS providers and has two arms: Advanced and Basic. Advanced OH OBLS is recommended for EMS providers who are required to be certified in Advanced Cardiac Life Support (ACLS).

The goal of this course is to improve maternal-fetal outcomes in the setting of maternal cardiac arrest (MCA) by increasing provider awareness and practice using the techniques specific to maternal cardiac arrest. By the end of this course, the learner will have improved knowledge of the unique modifications to Basic Life Support (BLS) and ACLS in pregnancy and will be better prepared to treat pregnant people in cardiac arrest.

0.2 COURSE OBJECTIVES

Upon completion of OBLS, learners should be able to do the following:

• Understand how to apply the differences in pregnancy-related changes to physiology and anatomy to the performance of BLS and ACLS during MCA.

• Demonstrate how to recognize pending cardiopulmonary arrest in the pregnant and postpartum patient by applying one of the early warning sign algorithms for pregnancy.

• Demonstrate effective OBLS with an emphasis on effective chest compressions with early activation of left uterine displacement (LUD) and automated external defibrillator (AED) use as indicated.

• In the setting of cardiac arrest in reproductive-age people (pregnancy status unknown), efficiently apply point-of-care ultrasound (POC-US), where applicable, to diagnose possible pregnancy and initiate required BLS/ACLS changes quickly and effectively.

• Efficiently apply pregnancy-specific changes to the ACLS algorithm, with an emphasis on early resuscitative cesarean delivery (RCD) within 5 minutes of arrest if pregnancy is suspected to be greater than 20 weeks or at the level of the maternal umbilicus and initial round of cardiopulmonary resuscitation (CPR) is ineffective at return of spontaneous circulation (ROSC).

• Apply unique modifications to the primary survey in a person of reproductive age undergoing trauma.

• Initiate immediate post-arrest care in the setting of ROSC, with special consideration to pregnancy/postpartum state.

• Consider extracorporeal cardiopulmonary resuscitation (ECPR) in those cases refractory to ROSC.

• Demonstrate clear and effective team communication using a TeamSTEPPSTM approach.

• Improve communication to the healthcare team and families in the setting of poor outcomes.

• Recognize proper disposition/transfer of care for a pregnant patient in cardiopulmonary arrest.

• Recognize and treat possible reversible causes of MCA.