Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests

doi:10.1016/j.resuscitation.2003.08.004

Resuscitation

Volume 60, Issue 1, January 2004, Pages 51-56

https://doi.org/10.1016/j.resuscitation.2003.08.004 Get rights and content

Abstract

Aim: Cardiopulmonary resuscitation is a team endeavour. There are only limited data on whether team performance during cardiopulmonary resuscitation is influenced by behavioural issues. The aim of the study was to determine whether and how human factors affect the quality of cardiopulmonary resuscitation. Methods: 16 teams, each consisting of three health-care workers, were studied in a patient simulator. A scenario of witnessed cardiac arrest due to ventricular fibrillation was used. Ventricular fibrillation could be converted into sinus rhythm by two countershocks administered during the first 2 min or by two countershocks administered during the first 5 min provided that uninterrupted basic life support was started in under 60 s. Teams were rated to be successful if ventricular fibrillation was converted into sinus rhythm. Behavioural rating included leadership, task distribution, information transfer, and conflicts. Results: Only six out of 16 teams were successful. Compared with successful teams, teams that failed exhibited significantly less leadership behaviour (P=0.033) and explicit task distribution (P=0.035). All teams shared among them sufficient theoretical knowledge to successfully treat the simulated cardiac arrest. Conclusions: In a scenario of simulated witnessed cardiac arrest almost two thirds of teams composed of qualified health-care workers failed to provide basic life support and/or defibrillation within an appropriate time window. Absence of leadership behaviour and absence of explicit task distribution were associated with poor team performance. Failure to translate theoretical knowledge into effective team activity appears to be a major problem.

Sumàrio

Objectivo: A ressuscitação cardiopulmonar é um esforço de equipe. Existe apenas informação limitada sobre se a performance da equipe durante a ressuscitação é influenciada por aspectos comportamentais. O objectivo deste estudo foi determinar se e de que forma os factores humanos afectam a qualidade da ressuscitação cardiopulmonar. Métodos: Dezasseis equipes, cada uma consistindo de 3 profissionais de saúde, foram estudadas num simulador de doente. Foi utilizado um cenário de paragem cardı́aca testemunhada devida a fibrilhação ventricular. A fibrilhação ventricular podia ser convertida em ritmo sinusal por 2 choques administrados durante os primeiros 2 minutos ou por 2 choques administrados durante os primeiros 5 minutos desde que tivesse sido iniciado suporte básico de vida ininterrupto antes dos 60 segundos. As equipes foram classificadas como tendo sucesso se a fibrilhação ventricular fosse convertida a ritmo sinusal. A avaliação comportamental incluiu a liderança, distribuição de tarefas, transferência de informação e conflitos. Resultados: Apenas 6 das 16 equipes tiveram sucesso. Em comparação com as equipes bem sucedidas, as que falharam exibiram comportamentos de liderança significativamente menores (P=0,033) bem como de distribuição explı́cita de tarefas (P=0,035). Todas as equipes partilhavam entre si suficientes conhecimentos teóricos para tratarem com sucesso a paragem cardı́aca simulada. Conclusões: Num cenário simulado de paragem cardı́aca testemunhada quase 2/3 de equipes compostas por profissionais de saúde qualificados falharam em proporcionar suporte básico de vida e/ou desfribrilhação num espaço de tempo apropriado. A ausência de comportamentos de liderança e ausência de distribuição explı́cita de tarefas estiveram associadas com má performance da equipe. A falência na transferência de conhecimentos teóricos para a actividade efectiva das equipes parece ser um problema importante.

Resumen

Objetivos: La reanimación cardiopulmonar es una empresa de equipo. Existen datos limitados acerca de la influencia de asuntos de comportamiento individual sobre el desempeño del equipo de reanimación cardiopulmonar. El objetivo de este estudio es determinar si es que los factores humanos afectan la calidad de la reanimación cardiopulmonar, y de que manera la afectan. Métodos: 16 equipos, cada uno formado por tres trabajadores de cuidados de salud, fueron estudiados en un simulador de paciente. Se usó un escenario de paro cardı́aco presenciado debido a una fibrilación ventricular. La fibrilación ventricular podrı́a ser convertida hacia un ritmo sinusal por dos descargas administradas durante los dos primeros minutos o por 2 descargas administradas durante los primeros 5 minutos si se realizaba soporte vital básico sin interrupción, iniciado antes de los 60 segundos. Los equipos eran calificados como exitosos si la fibrilación ventricular era convertida a ritmo sinusal. La calificación de comportamiento incluı́a liderazgo, distribución de tareas, transferencia de información, y conflictos. Resultados: Solamente 6 de los 16 equipos fueron exitosos. Los equipos que fracasaron, comparados con los exitosos, mostraron comportamiento de liderazgo significativamente menor (P=0.033) y distribución explı́cita de tareas (P=0.035). Todos los equipos compartı́an entre ellos suficiente conocimiento teórico para tratar exitosamente el paro cardı́aco simulado. Conclusiones: En un escenario de paro cardı́aco simulado casi dos tercios de los equipos compuestos por personal calificado de salud fallaron en proporcionar soporte vital básico y/o desfibrilación dentro de una ventana de tiempo apropiada. Se asoció la ausencia de liderazgo y la ausencia de distribución explı́cita de tareas con el mal desempeño de grupo. El mayor problema parece ser la falla en traducir los conocimientos teóricos en actividad efectiva de equipo.

Introduction

Extensive guidelines and algorithms exist on how to proceed during cardiopulmonary resuscitation [1], [2], [3]. However, cardiopulmonary resuscitation is a team endeavour and several health-care workers need to co-ordinate their activities to ensure optimal team performance. Thus, apart from medical knowledge and technical skills, human factors are likely to be relevant in the quality of cardiopulmonary resuscitation. There are only limited data on the significance of behavioural issues in cardiopulmonary resuscitation. Accordingly, the aim of the present study was to assess whether and how human factors affect the team performance during a simulated cardiac arrest.

Section snippets

Setting

The study was undertaken during an international congress for intensive care. Participants of the congress (nurses and physicians) were invited to attend a workshop called ‘medical simulation’. For each slot two nurses and one physician could register so that each simulation could be carried out with a team of three health-care workers. Registrations were considered in the order they were received (‘first come, first served’) and no attempt was made to balance the teams according to the level

Results

Sixteen simulations were carried out. All nurses that participated in the workshop had had special training in intensive care and were, at the time of the workshop, working in intensive care. All physicians participating were, at the time of the workshop, working in intensive care. However, only two out of 16 physicians had completed their training in intensive care while the remaining 14 were residents.

Only six out of the 16 teams were successful: five teams administered two countershocks

Discussion

In the present study we focused on the first crucial minutes of a cardiac arrest. Almost two thirds of teams composed of health-care professional currently working in intensive care failed to treat a witnessed cardiac arrest according to established guidelines [1], [2], [3]. Failure was associated with absence of leadership behaviour and the absence of explicit task distribution among team members.

Cardiopulmonary resuscitation is a team endeavour. Surprisingly, there is only little data on

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