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Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: A randomized controlled trial*

Hunziker, Sabina MD; Bühlmann, Cyrill MD; Tschan, Franziska PhD; Balestra, Gianmarco MD; Legeret, Corinne MD; Schumacher, Cleo MD; Semmer, Norbert Karl PhD; Hunziker, Patrick MD; Marsch, Stephan MD, PhD

doi: 10.1097/CCM.0b013e3181cf7383
Clinical Investigations

Objective: The influence of teaching leadership on the performance of rescuers remains unknown. The aim of this study was to compare leadership instruction with a general technical instruction in a high-fidelity simulated cardiopulmonary resuscitation scenario.

Design: Prospective, randomized, controlled superiority trial,

Setting: Simulator Center of the University Hospital Basel in Switzerland.

Subjects: Two-hundred thirty-seven volunteer medical students in teams of three.

Intervention: During a baseline visit, the medical students participated in a video-taped simulated witnessed cardiac arrest. Participants were thereafter randomized to receive instructions focusing either on correct positions of arms and shoulders (technical instruction group) or on leadership and communication to enhance team coordination (leadership instruction group). A follow-up simulation was conducted after 4 mos.

Measurements and Main Results: The primary outcome were the amount of hands-on time, defined as duration of uninterrupted cardiopulmonary resuscitation in the first 180 secs after the onset of the cardiac arrest (hands-on time). Secondary outcomes were time to start cardiopulmonary resuscitation, total leadership utterances, and technical skills. Outcomes were compared based on videotapes coded by two independent researchers. After a balanced performance at baseline, the leadership instruction group demonstrated a longer hands-on time (120 secs; interquartile range, 98–135 vs. 87 secs; interquartile range, 61–108; p < .001), a shorter median time to start cardiopulmonary resuscitation (44 secs; interquartile range, 32–62; vs. 67 secs; interquartile range, 43–79; p = .018), and had more leadership utterances (7; interquartile range, 4–10; vs. 5; interquartile range, 2–8; p = .02) in the follow-up visit. The rate of correct arm and shoulder positions was higher in teams with technical instruction (59%; 19 out of 32; vs. 23%; 7 out of 31; p = .003).

Conclusions: Video-assisted leadership and technical instructions after a simulated cardiopulmonary resuscitation scenario showed sustained efficacy after a 4-mo duration. Leadership instructions were superior to technical instructions, with more leadership utterances and better overall cardiopulmonary resuscitation performance.

From Medical Intensive Care Unit (SH, CB, GB, CL, CS, PH, SM), University Hospital Basel, Basel, Switzerland; Department of Psychology (FT), University of Neuchâtel, Neuchâtel, Switzerland; Department of Psychology (NKS), University of Bern, Bern, Switzerland.

Drs. S. Hunziker and Bühlmann contributed equally to this work.

Study concept, study design, data collection, and analysis and writing of the report performed by Drs. Marsch, S. Hunziker, and Bühlmann. Drs. Balestra, Legeret, Tschan, Semmer, and Schumacher contributed substantially to planning of the study, data collection, interpretation of data, and/or writing of the manuscript.

The authors have not disclosed any potential conflicts of interest.

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© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins