Fernandez Castelao Ezequiel, Boos Margarete, Ringer Christiane, Eich Christoph, Russo Sebastian G
Department of Social and Communication Psychology, Georg-Elias-Müller Institute of Psychology, Georg-August-University Göttingen, Gosslerstraße 14, 37073, Göttingen, Germany.
Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
BMC Med Educ. 2015 Jul 24;15:116. doi: 10.1186/s12909-015-0389-z.
Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization.
Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV).
CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023).
Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.
心肺复苏（CPR）中有效的团队领导被公认为是影响操作表现的关键因素。一般来说，领导力培训侧重于对领导及非领导团队成员的任务要求。我们仅为接受过高级生命支持（ALS）培训团队的指定团队领导提供危机资源管理（CRM）培训。本研究评估了CRM团队领导培训对CPR操作表现及团队领导言语表达的影响。
将45个每组4名成员的团队随机分为两个研究组之一：CRM团队领导培训组（CRM-TL）和额外ALS培训组（ALS附加组）。在进行了一次初始讲座以及每次90分钟的三次ALS技能培训教程（基础生命支持、气道管理和心律识别/除颤）后，每个团队随机指定一名成员在即将到来的CPR模拟中担任团队领导。CRM-TL组的团队领导参加了90分钟的CRM-TL培训。所有其他参与者接受了额外90分钟的ALS技能培训。对模拟CPR场景进行录像，并分析无血流时间（NFT）百分比、对欧洲复苏委员会2010年ALS算法的依从性（ADH）以及团队领导言语表达（TLV）的类型和频率。
与ALS附加组相比，CRM-TL组的NFT率较短，尽管在统计学上无显著差异（平均差异1.34（95%CI -2.5，5.2），p = 0.48）。CRM-TL组的ADH得分显著更高（差异 -6.4（95%CI -10.3，-2.4），p = 0.002）。CRM-TL组的TLV比例显著更高：直接指令（差异 -1.82（95%CI -2.4，-1.2），p < 0.001）；非直接指令（差异 -1.82（95%CI -2.8，-0.9），p < 0.001）；规划（差异 -0.27（95%CI -0.5，-0.05），p = 0.01）和任务分配（差异 -0.09（95%CI -0.2，-0.01），p = 0.023）。
仅对指定的团队领导进行CRM培训可提高整个团队的表现，尤其是对指南的依从性和团队领导行为。强调团队领导行为培训似乎对复苏和急诊医疗课程表现有益。
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