Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests.
OBJECTIVE
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.
Marsch
Stephan C U
SC
Medical Intensive Care Unit, University of Basel, Kantonsspital, 4031 Basel, Switzerland. smarsch@uhbs.ch
Müller
Christian
C
Marquardt
Katja
K
Conrad
Gerson
G
Tschan
Franziska
F
Hunziker
Patrick R
PR
D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002983:Clinical Competence; D003220:Conflict, Psychological; D003422:Critical Care; D004554:Electric Countershock; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D033181:Information Dissemination; D007857:Leadership; D008297:Male; D008348:Manikins; D008875:Middle Aged; D009726:Nurses; D010348:Patient Care Team / Q000592:standards*; D010820:Physicians; D013647:Task Performance and Analysis; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy