Utilizing Simulation Training to Understand Maternal Cardiac Arrest Precipitated by Amniotic Fluid Embolism: A Quality Improvement Project

Abstract

Background and Problem: Maternal cardiac arrest precipitated by amniotic fluid embolism is among the leading direct causes of death among laboring women (Enomoto et al., 2022). Because it presents suddenly without any immediate apparent cause and lacks specific diagnostic tests, frontline obstetric caregivers must be vigilant, competent, and prepared to handle this potentially catastrophic emergency. Coordination among multiple disciplines is paramount since two lives, not just one, are at risk. Unfortunately, the rarity of maternal cardiac arrest significantly limits opportunities for staff to learn how to identify and manage these events successfully. Method: This quality improvement project established a simulation-based training course to improve staff knowledge, communication, and emergency response during maternal cardiac arrest caused by amniotic fluid embolism. Intervention and Implementation: Two simulation sessions were conducted. The first was voluntary, involving pre- and post-tests, as well as skill self-assessments. The second was unannounced, designed to simulate real-time clinical pressure. Debriefings were held following both sessions to highlight strengths, identify gaps, and deliver targeted education. Results: The announced session showed improved post-test scores and confidence. The unannounced session revealed delays in epinephrine administration, confusion over code activation, unfamiliarity with the code cart, and overcrowding. The lack of ACLS certification among labor and delivery nurses was a noted barrier. Conclusion: Simulation improved individual and team preparedness, revealing key system vulnerabilities. Sustainability is achievable through routine training and expansion