Hunziker S, Tschan F, Semmer N K, Howell M D, Marsch S
Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.
J Emerg Trauma Shock. 2010 Oct;3(4):389-94. doi: 10.4103/0974-2700.70764.
Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR). Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.
医学算法、技术技能和反复训练是成功进行心肺复苏（CPR）的经典基石。越来越多的证据表明，包括团队互动、沟通和领导能力在内的人为因素也会影响心肺复苏的实施效果。然而，指南尚未纳入这些人为因素，部分原因是在现实生活中的心脏骤停事件中难以对其进行测量。最近，利用高保真视频辅助模拟进行的心脏骤停场景临床研究，为更好地描述人为因素对复苏团队表现的影响提供了机会。本综述重点关注来自模拟器研究的证据，这些研究聚焦于人为因素及其对复苏团队表现的影响。与对真实患者的研究类似，模拟心脏骤停场景显示出许多对心肺复苏的不必要中断以及除颤的显著延迟。这些研究还表明，人为因素在这些不足中起主要作用，而且医疗表现取决于领导能力和团队结构的质量。此外，模拟录像的医疗紧急情况显示，沟通期间相当一部分信息传递是错误的。要理解人为因素对像复苏这样复杂的医疗干预表现的影响，需要对涉及患者、除颤器等复苏设备以及所有团队成员的因素进行逐秒详细分析。因此，高保真模拟器研究为这个具有挑战性的领域提供了一种重要的研究方法。
