Mr Benjamin STANTON1
1SA AMBULANCE SERVICE, ,
Abstract:
The purpose of the presentation
To review the current literature on resuscitative hysterotomy and discuss a case study of 31-year-old maternal cardiac arrest leading to a pre-hospital resuscitative hysterotomy involving the South Australian Ambulance Service (SAAS) and MedSTAR.
The nature and scope of the topic
Cardiac arrest during pregnancy remains the leading cause of maternal deaths world-wide. The incidence in this population is estimated at around 1 per 30,000 pregnancies. Specific considerations need to be made from the standard advanced life support (ALS) algorithm in pregnancy, the biggest one is the decision to remove the foetus after 4 minutes of cardiac arrest. A resuscitative hysterotomy, is an emergent clinical procedure that involves the rapid delivery of the foetus from the pregnant mother in cardiac arrest in order to improve the mother’s survival.
The issue or problem under consideration
It is a procedure that is well documented and described in the literature, but very infrequently encountered in the pre-hospital and retrieval environment. It is a lifesaving procedure, focused mainly on the mother, that can be performed by critical care clinicians with no more than a scalpel. Like all rare clinical procedures such as performing a clamshell thoracotomy in cardiac arrest for penetrating trauma or in this case a resuscitative hysterotomy for maternal cardiac arrest in the pre-hospital and retrieval environment, timing to conduct the procedure is crucial, but might not be the 4 minute rule. Also education, training and simulation form the key elements to its success in the field.
The outcome or the conclusion reached
The use of low fidelity pregnancy manikin-based scenarios and decision making tools to train personnel for the real thing is invaluable to get the best out of your teams for this extremely rare procedure to be undertaken in the pre-hospital and retrieval space.
Biographies:
Ben Stanton is a Nurse Practitioner specialising in aeromedical retrieval & transport, currently employed at South Australian Ambulance Service (SAAS) MedSTAR Emergency Medical Retrieval Service. He is passionate about the nurse’s role in the stabilisation, management and transportation of the critically ill medical and trauma patient, as well as clinical education and simulation training. He is a member of AUSMAT, the Australian Government’s emergency and disaster response capability for Australia and is an active specialist reserve member of the Royal Australian Air Force (RAAF) specialising in the transportation of the critically ill & injured.