Sabina Hunziker1, Karen J O'Connell2, Claudia Ranniger3, Lillian Su2, Seraina Hochstrasser4, Christoph Becker5, Daryl Naef4, Elizabeth Carter2, David Stockwell6, Randall S Burd7, Stephan Marsch8. 1. Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland. Electronic address: Sabina.Hunziker@usb.ch. 2. Children's National Medical Center, Washington, DC, United States. 3. Clinical Learning and Simulation Skills (CLASS) Center, The George Washington University, Washington, DC, United States. 4. Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland. 5. Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, University of Basel, Switzerland. 6. Patient Safety and the Pediatric Intensive Care Unit, Children's National Medical Center, Washington, DC, United States. 7. Children's National Medical Center, Department of Surgery, Washington, DC, United States. 8. Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland.
Abstract
OBJECTIVE: During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied. METHODS: This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance. RESULTS: We included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams. CONCLUSIONS: Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.
RCT Entities:
OBJECTIVE: During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied. METHODS: This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance. RESULTS: We included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams. CONCLUSIONS: Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.
Authors: Sami Rifai; Timur Sellmann; Dietmar Wetzchewald; Heidrun Schwager; Franziska Tschan; Sebastian G Russo; Stephan Marsch Journal: Int J Environ Res Public Health Date: 2020-10-29 Impact factor: 3.390
Authors: Vittal Hejjaji; Apurba K Chakrabarti; Brahmajee K Nallamothu; Theodore J Iwashyna; Sarah L Krein; Brad Trumpower; Marci Kennedy; Khaja Chinnakondepalli; Ali O Malik; Paul S Chan Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-10-28