Bridging Specialties: Internal Medicine and Obstetric In Situ Cardiac Arrest Training

Introduction: The 2020 American Heart Association’s (AHA) cardiopulmonary resuscitation (CPR) guidelines recommend in-situ resuscitation training. Evidence has shown that in-situ training can have positive impacts on provider knowledge, patient outcomes, and quality improvement by identifying patient safety threats. This quality improvement project used a multidisciplinary approach to enhance communication, role delineation, and patient outcomes in an obstetric cardiac arrest simulation environment.


Methods: An in-situ obstetric cardiac arrest during labor induction for pre-eclampsia with severe features was performed on the labor and delivery floor. Obstetrics/gynecology residents, labor and delivery nurses, rapid response team, and a dedicated cardiac arrest team of internal medicine residents were assigned to the simulation and provided with a pre-brief including date of the training in advance. Staff utilized current hospital procedures for cardiac arrest. A debrief was performed with participants and observers immediately following the simulation and a survey questionnaire was administered.


Results: Of the surveys returned, 71.8% reported that they had not been involved in a cardiac arrest within the last 3 months. When asked how often obstetric in-situ training should occur, 50% responded every 6 months and 34.4% responded every 3 months. The majority felt positively impacted by the in-situ training in their ability to improve communication, provide role clarity, utilize alert protocols, and identify safety threats. Additionally, feedback from the debrief was used to improve hospital policy for obstetric emergency events.


Conclusions: In-situ CPR training is recommended by the AHA 2020 guidelines to improve learning and patient outcomes by identifying patient safety threats and prompting quality improvement processes. There is a lack of in-situ CPR training for obstetric patients, especially on labor and delivery floors, likely due to a low prevalence of cardiac arrests in this setting. Our results demonstrate the gap in knowledge and skills in this particular setting with noted post-education improvement in provider confidence levels. Regular in-situ training is essential to improve patient outcomes, interdisciplinary teamwork, and optimize ACLS performance.