title: Activities during interruptions in cardiopulmonary resuscitation: a simulator study.
abstract: OBJECTIVE
  Studies investigating the quality of cardiopulmonary resuscitation (CPR) have revealed frequent unnecessary interruptions of life support. The primary objective of the study is to analyze what happens during interruptions. We investigated (a) whether interruptions are filled with "secondary activities", i.e., activities only indirectly related to the primary task of providing life support (e.g., preparatory and diagnostic activities), and (b) whether all group members focus on the same secondary activity during interruptions, thus impeding group coordination, and detracting from the primary task of providing life support.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Twenty teams of general practitioners were videotaped during a simulated cardiac arrest.
  
  
  METHODS
  Resuscitation performance was assessed as hands-on time according to resuscitation guidelines. Unnecessary interruptions were defined as periods the patient received no hands-on support.
  
  
  RESULTS
  Teams of general practitioners achieved hands-on time in accordance with the resuscitation guidelines (chest compression/ventilation/defibrillation) during 62% of the time the patient had no pulse. Unnecessary interruptions consumed 32% of the available time. During most of the unnecessary interruption time, team members engaged in secondary medical activities, particularly observing the monitor (47%) and dealing with the defibrillator (47%). During 56% of the unnecessary interruption time, all team members focussed their attention on the same secondary activity, thus neglecting the need for task distribution among team members.
  
  
  CONCLUSIONS
  Unnecessary interruptions of CPR occur frequently and consume approximately one-third of the time patients should receive continuous life support. Unnecessary interruptions are mainly characterized by secondary medical activities that may be perceived as meaningful. During the majority of unnecessary interruptions, all team members focus on the same secondary activity, indicating shortcomings in task distribution in the resuscitation team. The findings emphasize the importance of team training with particular emphasis on situational awareness and task distribution.
authors.affiliation: Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland. franziska.tschan@unine.ch
authors.forename: Franziska
authors.initials: F
authors.lastname: Tschan
authors.forename: Maria
authors.initials: M
authors.lastname: Vetterli
authors.forename: Norbert K
authors.initials: NK
authors.lastname: Semmer
authors.forename: Sabina
authors.initials: S
authors.lastname: Hunziker
authors.forename: Stephan C U
authors.initials: SC
authors.lastname: Marsch
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards*; D058006:General Practice; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008348:Manikins; D011446:Prospective Studies