From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany.
Consultant, Brooklyn.
Pediatr Emerg Care. 2022 Feb 1;38(2):e978-e982. doi: 10.1097/PEC.0000000000002507.
The aims of the study were to assess whether preassigning a team leader influences resuscitation timing using simulation and to examine relationship between response timeliness and designated leader's profession, whether physician or nurse.
This is a prospective study of intervention (leader assigned) and control (no assigned leader) teams of residents and nurses participating in a simulated scenario. The primary outcome was time to bag-valve-mask (BVM) ventilation. A secondary outcome measure compared difference in time to BVM between physician- and nurse-led teams.
We assessed 25 teams, leader assigned (n = 14) or control (n = 11), composed of 92 clinicians. Leaders emerged in most of the controls (10 of 11). The median time to BVM in the leader-assigned group was 41.5 seconds (interquartile range, 34-49 seconds) compared with 53 seconds (interquartile range, 27-85 seconds) for controls (P = 0.13). In the leader-assigned group, 85% (12 of 14) of teams initiated BVM in less than 1 minute compared with only 54% teams (6 of 11) in controls (P = 0.18). Among the leader-assigned teams, we randomly assigned residents to lead 8 teams and nurses to lead 6 teams. All the nurse-led teams (6 of 6) initiated BVM in less than 1 minute compared with fewer physician-led teams (6 of 8) and only approximately half of controls (6 of 11, P = 0.19).
The leader-assigned teams and controls did not differ in resuscitation timeliness. Among leader-assigned teams, the differences in time to BVM between physician- and nurse-led teams were not statistically significant. However, all 6 nurse-led teams demonstrated timely resuscitation, suggesting a direction for future research on the feasibility of bedside nurses taking the lead during resuscitation, pending code team arrival.
本研究旨在评估在模拟场景中预先指定团队负责人是否会影响复苏时机，并研究响应及时性与指定负责人（医生或护士）职业之间的关系。
这是一项对参与模拟场景的住院医师和护士的干预（指定负责人）和对照（无指定负责人）团队的前瞻性研究。主要结局指标是球囊面罩通气（BVM）的时间。次要结局指标比较了医生和护士领导的团队之间 BVM 时间的差异。
我们评估了 25 个团队，其中 14 个为负责人分配组，11 个为对照组，由 92 名临床医生组成。大多数对照组（11 个中的 10 个）都出现了负责人。负责人分配组的 BVM 中位时间为 41.5 秒（四分位间距，34-49 秒），对照组为 53 秒（四分位间距，27-85 秒）（P=0.13）。在负责人分配组中，85%（14 个中的 12 个）的团队在 1 分钟内开始 BVM，而对照组中只有 54%（11 个中的 6 个）（P=0.18）。在负责人分配组中，我们随机分配住院医师领导 8 个团队，护士领导 6 个团队。所有护士领导的团队（6 个中的 6 个）都在 1 分钟内开始 BVM，而医生领导的团队则较少（6 个中的 6 个），只有大约一半的对照组（11 个中的 6 个，P=0.19）。
负责人分配组和对照组在复苏及时性方面没有差异。在负责人分配组中，医生和护士领导的团队之间 BVM 时间的差异没有统计学意义。然而，所有 6 个护士领导的团队都表现出及时的复苏，这表明在等待急救小组到达时，床边护士在复苏期间担任负责人的可行性值得进一步研究。
