Decoding Code OB: A National Survey of Obstetrical Emergency Codes

OBJECTIVES: Increasing incidence of maternal cardiac arrest, with a significant case fatality rate, highlights the urgent need for empirical protocols to inform how multiprofessional teams respond to these events. Existing international guidelines recommend a unique emergency response code for maternal cardiac arrest, without clear guidance regarding implementation. Canadian data is currently lacking, which limits our ability to compare outcomes and capture opportunities for improvement nationally and institutionally. This study maps the range of existing obstetrical emergency codes and team responses across Canada. METHODS: We extracted institutional information from publicly available documents or key informants in obstetrical units at 28 of 32 teaching hospitals across Canada with obstetrical beds (excluding Québec), including current obstetrical code(s), practical details and evaluation procedures if specified. A composite code included many different emergencies, a combined code merged ≥2 existing codes, and a dedicated code was specific to 1 emergency. RESULTS: Overall, 50% of surveyed units use at least 1 obstetrical emergency code, most commonly for time-critical obstetrical emergencies. Only 21% (N = 6) of teaching hospitals surveyed have a either a composite (N = 3) or combined code (N = 3) that includes maternal cardiac arrest and only 1 hospital had a unique, dedicated maternal arrest code. CONCLUSIONS: Despite guidelines that support the use of a dedicated code for maternal cardiac arrest, this is rare across the sampled centres. Instead, composite or combined codes were more common, with unproven safety or efficacy. Our findings expose a national opportunity to standardize and systematically research in-hospital maternal arrest protocols to optimize relevant patient outcomes.