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A simple mnemonic to remember team tasks during cardiopulmonary resuscitation

Sen, Indu M.; Kumar, Rakesh1; Grewal, Anju2; Singh, Manpreet3

Author Information
Journal of Anaesthesiology Clinical Pharmacology: July–September 2021 - Volume 37 - Issue 3 - p 486-487
doi: 10.4103/joacp.JOACP_373_19
  • Open

Cardiac arrest remains a life-threatening disease with poor outcome. A multi-rescuer coordinated cardiopulmonary resuscitation (CPR) is expected to improve the survival to discharge.[1] To save a life, prompt and systematic involvement of a group of personnel (team) is required. Advanced Cardiovascular Life Support Provider Manuals recommend 8 elements for effective resuscitation while performing CPR as a team.[2] These 8 elements are: Closed loop communication, Clear messages, Clear roles and responsibilities, Knowing one's limitations, Knowledge sharing, Constructive intervention, Re-evaluation and summarizing, and Mutual respect.[3] Learning all these elements of ‘team dynamics’ and then using them during a code is an important determinant of the success of CPR. It has been observed that mnemonics/checklists improve one's ability to remember a set of information.[3] While in the case of resuscitation-related information, these memory-aids has the potential of improving rescuer's technical abilities and confidence in providing effective CPR.[34] We suggest a simple mnemonic in the form of a equation to remember the eight elements of effective resuscitation team dynamics.

The mnemonic is C4P2R2. It is described as follows:

C - Clear messages to avoid human errors due to ambiguity in the message given.

C - Clear assignment of roles & responsibilities to facilitate prompt resuscitation by the most appropriate team member.

C - Closed loop communication to ascertain the correct transmission of messages between the team coordinator and team members regarding allocation and completion of a task.

C - Constructive interventions to prevent inappropriate actions.

P - Personal limitations acknowledgement to ensure that every task during the code is being conducted by the most appropriate person in the team (including the team leader).

P - Personal knowledge sharing to extract and share any new information, idea or differential diagnosis amongst the team members and avoid fixation errors.

R - Revaluation and summarization of patient's assessment findings, interventions performed and for remaining open to think about new differential diagnoses according to changing patient's condition.

R - Respectful behavior amongst all the team members to promote an environment of working together in a supportive manner without any ego clashes.

It is suggested that once a code is alerted, while on their way to the patient, all the team members (including the team coordinator) can use this “equation” to quickly revise all the elements of effective team dynamics. And during resuscitation the “equation” can again be used to review the code from time to time. We, at our centers are advocating it. Delegates find it easy to remember and apply these elements during hands on sessions. McCoy et al. has suggested about the superiority of simulator based training.[5] Further trials can be planned to substantiate efficacy of C4P2R2 equation in improving learning experience and inter-personal relationships in simulator based CPR training sessions.

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Conflicts of interest

There are no conflicts of interest.

1. Soar J, Donnino MW, Maconochie I, Aickin R, Atkins DL, Andersen LW, et al International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary Resuscitation. 2018;133:194–206
2. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation. 2020;142(16, suppl 2):S366–S468
3. Hafner JW, Sturgell JL, Matlock DL, Bockewitz EG, Barker LT. “Staying’ alive”: A novel mental metronome to maintain compression rates in simulated cardiac arrests J Emerg Med. 2012;43:e373–7
4. Sen I, Sen M. “DIRECT CPR”- Mnemonic to remember 2010 AHA BLS CPR guidelines Ind J Crit Care Med. 2014;18:261
5. McCoy CE, Rahman A, Rendon JC, Anderson CL, Langdorf MI, Lotfipour S, Chakravarthy B. Randomized controlled trial of simulation vs standard training for teaching medical students high-quality cardiopulmonary resuscitation. West J Emerg Med. 2019;20:15–22
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