RESUMEN
BACKGROUND: Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization. METHODS: Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV). RESULTS: CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023). CONCLUSION: Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.
Asunto(s)
Reanimación Cardiopulmonar/educación , Gestión de Recursos de Personal en Salud/métodos , Paro Cardíaco/terapia , Liderazgo , Grupo de Atención al Paciente , Entrenamiento Simulado/métodos , Adulto , Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/normas , Comunicación , Femenino , Humanos , Masculino , Grupo de Atención al Paciente/normasRESUMEN
OBJECTIVES: The percentage of hands-on time during cardiopulmonary resuscitation is a major determinant of patient outcome. We hypothesized that airway management with the intubating laryngeal mask airway (ILMA) would give greater hands-on time than with bag-mask ventilation (BMV), followed by direct laryngoscopy (DL), particularly in difficult-to-manage airways. PARTICIPANTS AND METHODS: Thirty paramedics and 40 medical students performed four standardized, 6-min cardiopulmonary resuscitation scenarios with the SimMan3G in a random sequence. These were normal and difficult-to-manage airways using either BMV+DL or ILMA. RESULTS: The time to the first successful ventilation was significantly longer with the ILMA (P<0.001). Hands-on time was lower for the ILMA after 2 min (67±8 vs. 81±8 s for BMV+DL, P<0.001), but was then significantly greater from the third minute onward (115±11 vs. 104±9 s for BMV+DL, P<0.001). The success rate of the first intubation attempt was higher and the time to ET placement was shorter with the ILMA, especially in the difficult-to-manage airway (P<0.001). CONCLUSION: In this manikin-based study, hands-on time was greater with the ILMA than with BMV+DL. The ILMA was particularly useful in increasing hands-on times in the difficult-to-manage airway.