Maternal cardiac arrest: a simulation-based review of anesthetic protocols and perimortem cesarean delivery

PURPOSE OF THE REVIEW: This review summarizes the current state of the art in maternal cardiac arrest and cesarean delivery and the rationale for and use of simulation to facilitate training in this rare but critical event. RECENT FINDINGS: Stabilization of the mother and consideration of the '4P's' and multidisciplinary management postarrest remain critical. Some key updates on management of maternal cardiac arrest include manual left uterine displacement and early/immediate preparation for resuscitative hysterotomy, with less focus on a 4-min window for intervention. Drawing lessons from other disciplines, high-fidelity simulation and skills development incorporating partial task training offer useful tools. Simulation-based training approaches focus on developing confidence, knowledge, skills, and teamwork related to maternal cardiac arrest and resuscitative hysterotomy. A variety of simulation approaches focused on different provider types address maternal cardiac arrest scenarios. Limited evidence suggests that presimulation education improved knowledge gains and skills. Resuscitative hysterotomy work has focused mostly on the development and use of low-cost task trainer models. More research is needed to identify systems impact of these training modalities. SUMMARY: Management of maternal cardiac arrest is a specialized skill set requiring additional training. Simulation may improve confidence, knowledge, and skills in management, but further study is needed to rigorously compare interventions and explore impact at a systems level.