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

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. 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 ininter