Authors (including presenting author) :
Tang YN(1), Lui CT(2), So PL(3), Ng P(2), Wong CY(1), So FL(2)
Affiliation :
(1)Accident and Emergency Department, Pok Oi Hospital, (2)Accident and Emergency Department, Tuen Mun Hospital, (3)The Department of Obstetrics and Gynaecology, Tuen Mun Hospital
Introduction :
PMCS is a crash caesarean delivery performed to resuscitate a woman in middle to late pregnancy with cardiac arrest. According to international recommendations, delivery is part of resuscitation process to relieve aortocaval compression and facilitate return of spontaneous circulation. It should be initiated if spontaneous circulation has not returned within four minutes of maternal cardiorespiratory collapse and delivery should be completed within five minutes. It is a rarely performed procedure but logistically demanding with the tight clinical time-frame, and virtually impossible to meet the standard unless a well-prepared multidisciplinary protocol is in-situ.
Objectives :
To establish and implement a multidisciplinary, well-structured PMCS workflow in Tuen Mun Hospital (TMH), Pok Oi Hospital (POH) and Tin Shui Wai Hospital (TSWH), aiming to (1) improve the preparedness among frontline colleagues with the situation, (2) allow it to be carried out efficiently as soon as possible and, therefore, (3) targeting to improve the maternal and fetal outcomes.
Methodology :
The PMCS workflow involves the collaborative effort from departments of Accident & Emergency (AED), Obstetrics, Pediatrics and Intensive Care Unit (ICU) in resuscitation of pregnant woman and neonate at AED. For pregnant woman with estimated gestational age of ≥24 weeks and cardiac arrest under resuscitation, designated PMCS call will be activated upon paramedic alert call before hospital arrival to start the preparation.
In TMH, the patient will be conjointly resuscitated by obstetricians, intensivists and pediatricians together with emergency physicians. Cardiopulmonary resuscitation will be continued by emergency physicians and intensivists while obstetricians will carry out PMCS with pre-arranged equipment. After delivery, the newborn will be handed over to pediatricians for neonatal resuscitation. The labour ward, neonatal ICU, operating theater, blood bank will be alerted for preparation. Other parties, including anesthetist and medical social worker will also be informed to provide supports accordingly. In POH and TSWH where obstetric support is not available, the workflow is modified and the decision of PMCS is made by senior emergency physician, with surgical and resuscitation support from on-duty surgeons and physicians respectively.
Result & Outcome :
A comprehensive service enhancement programme, including standardized PMCS protocol, a series of drills and training has been accomplished since October 2017. Awareness, vigilance and preparedness has been improved in all relevant clinical stakeholders to prepare for this rare, time-critical, and potentially life-saving procedure for both the mother and fetus.
