COURSE OVERVIEW
COURSE DESCRIPTION The Obstetric Life Support (OBLS) course has been created for All healthcare workers who may encounter and participate in the management of maternal medical emergencies including maternal cardiopulmonary arrest (MCA). The target audience for OBLS includes: obstetrician and gynecologists (OB/GYN), emergency department (ED) personnel, critical care healthcare workers, nurses, midwives, anesthesiologists, certified nurse anesthetists, technicians or other personnel involved in a rapid response team, and all levels of emergency medical services (EMS) personnel. There are two broad areas of applicability of the OBLS course: in- hospital (IH) and out-of-hospital (OH). The IH applies to healthcare workers who care for pregnant people on inpatient wards and ED settings. The OH applies to EMS and front-line healthcare workers in ambulatory clinics or standalone urgent care centers and has two arms: Advanced and Basic. Advanced OH OBLS is recommended for healthcare workers who are required to be certified in Advanced Cardiac Life Support (ACLS). The goal of this course is to improve maternal-fetal outcomes in the setting of various maternal medical emergencies that may result in maternal collapse and MCA. By the end of this course, the OBLS participant will have improved knowledge on managing maternal medical emergencies and will be better prepared to treat pregnant people in cardiac arrest.
COURSE OBJECTIVES Upon completion of OBLS, learners should be able to: • Recognize maternal vulnerabilities that result from changes in the cardiovascular, respiratory, hematologic, gastrointestinal, genitourinary, endocrinologic and immunologic systems.
• Review the most common etiologies of MC and recognize the presenting symptoms and signs of the etiologies that may lead to MCA.
• Determine how to apply the differences in pregnancy-related changes to physiology and anatomy to the performance of BLS and ACLS during MCA.
• Demonstrate how to recognize pending cardiopulmonary arrest in the pregnant and postpartum patient by applying one of the early warning sign algorithms for pregnancy.
• Demonstrate effective OBLS with an emphasis on effective chest compressions with early activation of left uterine displacement (LUD) and automated external defibrillators (AED) use as indicated.
• Apply point-of-care ultrasound (POC-US) in the setting of cardiac arrest in a reproductive age person with unknown pregnancy status to determine need for OBLS.
• Initiate pregnancy-specific changes to the ACLS algorithm, with an emphasis on early resuscitative
cesarean delivery (RCD) within five minutes of arrest if pregnancy is suspected to be > 20 weeks (or at the level of the maternal umbilicus) and initial round of cardiopulmonary resuscitation (CPR) does not result in return of spontaneous circulation (ROSC).
• Apply unique modifications to the primary survey in a person of reproductive age undergoing trauma.
• Initiate immediate post-arrest care in the setting of ROSC, with special consideration to pregnancy/postpartum state.
• Consider extracorporeal cardiopulmonary resuscitation (ECPR) in those cases refractory to ROSC. • Demonstrate clear and effective team communication using a Team STEPPS® approach. • Improve communication to the health care team and families in the setting of poor outcomes. • Recognize proper disposition/transfer of care for a pregnant patient in cardiopulmonary arrest. • Recognize and treat possible reversible causes of MCA.
COURSE DESIGN PRE-WORK Self-paced eLearning Course. The course consists of 10 modules and provides an overview of the physiology and anatomy of pregnant patients, with each module building on the previous one. The physiology and anatomy of pregnant patients are drastically different from nonpregnant patients. Consequently, OBLS teaches how to modify BLS and ACLS in the setting of MCA. Understanding the impact of pregnancy on anatomy and physiology empowers healthcare workers to improve care and outcomes for their patients. The course also highlights the common causes of MCA and introduces special procedures and effective team communication during MCA. Each module has interactive learning, videos, animations, and knowledge checks to reinforce the learner’s knowledge and skills.
OBLS ENTRY EXAM At the conclusion of the OBLS eLearning course, learners are required to take and pass an entry exam covering the material covered in the course. OBLS used an Angoff method to set the minimum passing scores for OH Basic, OH Advanced, and IH par�cipants to ensure mastery of pre-work before the in-person training. A group of subject mater experts examined each ques�on and predicted how many minimally qualified candidates would answer the ques�on correctly. This method ensures that the passing grade of each of the three OBLS tracks is verifiable and empirically determined.
INSTRUCTOR-LED, IN-PERSON COURSE Learners will participate in small-group, simulation-based course building on the foundations of OBLS learned in the pre-work. Instructors will lead groups in rapid-cycle deliberate practice on: •
Team communication and dynamics management
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Leading and managing MCA
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Techniques such as chest compressions on a pregnant patient, LUD, and RCD Cardiac rhythm interpretation and vital sign management
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Application of ACLS drugs
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Debriefing for critical events
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Sharing difficult news with family members following an MCA
Each scenario will take learners through a maternal medical emergency that will result in MCA and the need for OBLS. For both group practice and the graded Megacode, instructors will use a validated scoring checklist as an objective grading system to ensure that learners have performed core concepts. Each concept is linked to a point system yielding a grade for each, and pass/fail criteria are based on this grade. Using this checklist helps to eliminate instructor subjectivity and provides a permanent record of the learner’s performance.
GRADED OBLS MEGACODE Instructors will test each learner on how well they manage an OBLS Megacode scenario. Learners may find the Megacode checklists, by which instructors will test them, at the OBLS website (www.obls.org) or the eLearning course Resource Center.
COURSE PREREQUISITES Learners must be proficient in BLS skills before taking OBLS; a basic understanding of ACLS is beneficial but not required.
SUCCESSFUL COURSE COMPLETION REQUIREMENT
To complete OBLS, the learner must complete and pass both a competency test based on the OBLS eLearning course and a team leader assessment during the in-person training Megacode.
COURSE MATERIALS
Course materials include the OBLS eLearning course, the OBLS student website (www.obls.org), and the OBLS toolkit (e.g., algorithms, cognitive aids, and checklists).