Obstetric Life Support Education for Maternal Cardiac Arrest
Authors: Andrea D. Shields, Jacqueline Vidosh, Charles Minard, Brook Thomson, Kristen Annis-Brayne, Makayla Murphy, Laurie Kavanagh, Cheryl K. Roth, Monica A. Lutgendorf, Meredith L. Birsner, Stephen J. Rahm, Les R. Becker, Vincent Mosesso, Brian Schaeffer, Matthew Streitz, Utpal Bhalala, Andrea Gresens, John Phelps, Benjamin Sutton, Richard Wagner, Lissa M. Melvin, Kathleen Zacherl, Laura Karwoski, James Behme, Alex Hoeger, Peter E. Nielsen
Journal: JAMA Network Open (2024)

Importance Management of maternal cardiac arrest (MCA) requires understanding the unique physiology of pregnancy and modifications to life support. Health care professionals have historically demonstrated inadequate knowledge and skills necessary to treat MCA. Objective To evaluate the effect of Obstetric Life Support (OBLS) education on health care professionals’ cognitive performance, skills, and self-efficacy in managing MCA. Design, Setting, and Participants In this single-masked randomized clinical trial, 46 health care professionals, including emergency medical service and hospital staff representing diverse specialties, were randomized to intervention or control groups at a single academic medical center in Farmington, Connecticut between May 1, 2022, and July 23, 2023. Intervention The intervention group received OBLS education, which included a blended learning curriculum with simulation-based training on common maternal medical emergencies that lead to MCA. Participants were assessed for knowledge, confidence, and skills (eg, megacode scores as team leaders during MCA simulations). Intervention participants were compared with control group participants who received no OBLS education. Main Outcomes and Measures The primary outcome was cognitive scores. Secondary outcomes included megacode scores rated by experienced OBLS instructors masked to assignment groups, combined assessment pass rates, and cognitive and confidence scores at baseline and 6 and 12 months after education. Data were analyzed from January 2024 to May 2024. Results Forty-six participants (mean [SD] age, 41.1 [16.2] years; 24 [52%] women) were randomized. Despite most participants holding certification in basic and advanced cardiac life support, significant between-group differences were identified in knowledge, skills, and confidence. Mean (SD) cognitive scores were 79.5% (9.4%) in the intervention group vs 63.4% (12.3%) in the control group ( P &amp;amp;lt; .001). Mean (SD) megacode skills were higher in the intervention vs control group (91.0% [5.0%] vs 61.0% [12.0%], P &amp;amp;lt; .001), as were confidence scores (72.7 [13.3] vs 56.2 [17.9] points, P = .002). Combined assessment pass rates were 90% in the intervention group compared with 10% in the control group ( P &amp;amp;lt; .001). Conclusions and Relevance In this randomized clinical trial, OBLS education significantly improved health care professionals’ knowledge, skills, and confidence in managing MCA. These findings underscore the urgent need for implementation of a standardized MCA curriculum nationwide, especially as the US continues to face unacceptably high maternal mortality rates. Trial Registration ClinicalTrials.gov Identifier: NCT05355519