简短的领导力指导可提高高保真模拟心肺复苏中的表现：一项随机对照试验。

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

机构信息

Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.

出版信息

Crit Care Med. 2010 Apr;38(4):1086-91. doi: 10.1097/CCM.0b013e3181cf7383.

DOI:10.1097/CCM.0b013e3181cf7383

PMID:20124886

Abstract

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 was 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) [corrected]. 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.

摘要

目的

教学领导力对救援人员表现的影响尚不清楚。本研究的目的是比较高保真模拟心肺复苏场景中的领导力指导与一般技术指导。

设计

前瞻性、随机、对照优势试验。

地点

瑞士巴塞尔大学医院模拟器中心。

受试者

237 名志愿医学生，每组 3 人。

干预措施

在基线访问期间，医学生参加了一段录像模拟目击心脏骤停。参与者随后被随机分配接受专注于手臂和肩膀正确位置的指导（技术指导组）或专注于领导和沟通以增强团队协调的指导（领导力指导组）。4 个月后进行了后续模拟。

测量和主要结果

主要结果是实际操作时间，定义为心脏骤停后 180 秒内不间断心肺复苏的持续时间（实际操作时间）[校正]。次要结果是开始心肺复苏的时间、总领导话语和技术技能。根据两位独立研究人员编码的录像带比较结果。在基线时表现均衡后，领导力指导组的实际操作时间更长（120 秒；四分位距，98-135 与 87 秒；四分位距，61-108；p<0.001），开始心肺复苏的中位数时间更短（44 秒；四分位距，32-62 与 67 秒；四分位距，43-79；p=0.018），并且在后续访问中领导话语更多（7 次；四分位距，4-10 与 5 次；四分位距，2-8；p=0.02）。在技术指导组中，手臂和肩膀位置正确的比例更高（59%；19 比 32；与 23%；7 比 31；p=0.003）。