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- PublicationMétadonnées seulementActivities during interruptions in cardiopulmonary resuscitation: a simulator study(2011)
; ;Vetterli, Maria ;Semmer, Norbert K. ;Hunziker, SabinaMarsch, Stephan UOBJECTIVE: Studies investigating the quality of cardiopulmonary resuscitation (CPR) have revealed frequent unnecessary interruptions of life support. The primary objective of the study is to analyze what happens during interruptions. We investigated (a) whether interruptions are filled with "secondary activities", i.e., activities only indirectly related to the primary task of providing life support (e.g., preparatory and diagnostic activities), and (b) whether all group members focus on the same secondary activity during interruptions, thus impeding group coordination, and detracting from the primary task of providing life support. DESIGN: Prospective observational study. SETTING: Twenty teams of general practitioners were videotaped during a simulated cardiac arrest. OUTCOME MEASURES: Resuscitation performance was assessed as hands-on time according to resuscitation guidelines. Unnecessary interruptions were defined as periods the patient received no hands-on support. RESULTS: Teams of general practitioners achieved hands-on time in accordance with the resuscitation guidelines (chest compression/ventilation/defibrillation) during 62% of the time the patient had no pulse. Unnecessary interruptions consumed 32% of the available time. During most of the unnecessary interruption time, team members engaged in secondary medical activities, particularly observing the monitor (47%) and dealing with the defibrillator (47%). During 56% of the unnecessary interruption time, all team members focussed their attention on the same secondary activity, thus neglecting the need for task distribution among team members. CONCLUSIONS: Unnecessary interruptions of CPR occur frequently and consume approximately one-third of the time patients should receive continuous life support. Unnecessary interruptions are mainly characterized by secondary medical activities that may be perceived as meaningful. During the majority of unnecessary interruptions, all team members focus on the same secondary activity, indicating shortcomings in task distribution in the resuscitation team. The findings emphasize the importance of team training with particular emphasis on situational awareness and task distribution.
- PublicationMétadonnées seulementLeadership in medical emergencies depends on gender and personality(2011)
;Streiff, Seraina ; ;Hunziker, Sabina ;Buehlmann, Cyrill ;Semmer, Norbert K. ;Hunziker, PatrickMarsch, Stephan UNTRODUCTION: Leadership is an important predictor of team performance in medical emergencies. There are no data on why some healthcare workers take the lead in emergencies while others do not. Accordingly, the aim of the study was to determine predictors of leadership in a medical emergency. METHODS: Two hundred thirty-seven medical students in fourth year of medical school participated and filled in a questionnaire assessing knowledge, experience, and personality traits. Students were randomly assigned to 79 groups of three. Each group was confronted with a standardized scenario of a simulated witnessed cardiac arrest. The primary outcome was the predictors of the number of leadership statements during the first 3 minutes of the cardiac arrest. RESULTS: In the first 3 minutes of the cardiac arrest, the participants made a median of five leadership statements (range, 0-22; interquartile range, 2). Thirteen participants (5.5%) made no single leadership statement. Multivariate analysis revealed that male gender (unstandardized coefficient, 1.9; P = 0.01), extraversion (unstandardized coefficient, 0.9; P = 0.02), and agreeableness (unstandardized coefficient, -1.1; P = 0.023) predicted leadership statements. Context knowledge, context experience, and other personality traits had no significant effect on leadership. CONCLUSIONS: During the initial phase of a medical emergency, there is a substantial interindividual variation in the amount of leadership. Leadership behavior as assessed by the number of leadership statements is determined by gender and personality and not by knowledge or experience.
- PublicationMétadonnées seulementTeamwork and Leadership in Cardiopulmonary Resuscitation(2011-3-8)
;Hunziker, Sabina ;Johansson, Anna C ; ;Semmer, Norbert K. ;Rock, Laura ;Howell, Michael DMarsch, Stephan UDespite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.
- PublicationMétadonnées seulementPerceived stress and performance during a simulated resuscitation: A pilot study(2011-9-1)
;Hunziker, Sabina ;Laschinger, Laura ;Portmann, S ;Semmer, Norbert K. ;Marsch, Stephan U
- PublicationMétadonnées seulementImportance of leadership in cardiac arrest situations: from simulation to real life and back(2013-4-18)
;Hunziker, Sabina ; ;Semmer, NorbertMarsch, StephanThe 2010 American Heart Association guidelines now re- commend leadership training in Advanced Cardiac Life Support courses. In this review we provide a comprehens- ive summary of data derived from clinical studies that in- vestigated the importance of leadership in cardiopulmon- ary resuscitation (CPR). Only a few, mostly observational, studies have been conducted under real-life conditions be- cause of the high heterogeneity of the situations, diffi- culties in capturing the initial phase of CPR, and ethical issues. Well-controlled studies in the human simulator can fill existing gaps and provide important insights. High-fi- delity video-assisted simulator studies from different re- search groups have shown that a prolonged process of teambuilding is associated with significant shortcomings in CPR, whereas effective leadership improves team per- formance. In addition, randomised controlled studies have provided evidence that medical students receiving leader- ship training subsequently showed improved CPR perform- ance, which was sustained after a follow up of 4 months. In addition, leadership is influenced by gender and other factors such as emotional stress. Future studies are needed to investigate cultural differences and how findings from the simulator can be transferred to real-life situations.
- PublicationMétadonnées seulementImpact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: A randomized controlled trial(2013-9-14)
;Hunziker, Sabina ;Pagani, Simona ;Fasler, Katrin ; ;Semmer, Norbert K.Marsch, Stephan U.Abstract Background: Cardiopulmonary resuscitation (CPR) causes significant stress, which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task- focusing strategy on perceived stress levels and performance during a simulated CPR scenario. Methods: This prospective, randomized-controlled trial was conducted at the simulator-center of the University Hospital Basel, Switzerland. A total of 124 volunteer medical students were randomized to receive instructions about focusing on relevant task elements by posing two task-focusing questions (“what is the patient’s condition?”, “what immediate action is needed?”) when feeling overwhelmed by stress (intervention-group) or a control-group. The primary outcome was the perceived levels of stress and feeling overwhelmed (stress/overload); secondary outcomes were hands-on time, time to start CPR and number of leadership statements. Results: Participants in the intervention-group reported significantly less stress/overload levels compared to the control-group (mean difference: -0.6 (95%CI - 1.3, -0.1), p=0.04). Higher stress/overload was associated with less hands-on time. Leadership statements did not differ between groups, but the number of leadership statements did relate to performance. Hands-on time was higher in the intervention-group, but the difference was not statistically different (difference 5.5 (95%CI -3.1, 14.2), p=0.2); there were no differences in time to start CPR (difference -1.4 (95%CI - 8.4, 5.7), p=0.71). Conclusions: A brief task-focusing strategy decreased perceived stress without significantly affecting performance in a simulated CPR. Further studies should investigate more intense interventions for reducing stress.
- PublicationMétadonnées seulementLeadership in different resuscitation situations(2014)
; ;Semmer, Norbert K. ;Hunziker, Sabina ;Kolbe, Michaela ;Marsch, Stephan U.
- PublicationMétadonnées seulementABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial(2013-9-6)
;Marsch, Stephan U ; ;Semmer, Norbert ;Zobrist, Roger ;Hunziker, Patrick RHunziker, SabinaQUESTIONS UNDER STUDY: After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. METHODS: 108 teams, consisting of two physicians each, were randomized to receive a graphical display of either the ABC algorithm or the CAB algorithm. Subsequently teams had to treat a simulated cardiac arrest. Data analysis was performed using video recordings obtained during simulations. The primary endpoint was the time to completion of the first resuscitation cycle of 30 compressions and two ventilations. RESULTS: The time to execution of the first resuscitation measure was 32 ± 12 seconds in ABC teams and 25 ± 10 seconds in CAB teams (P = 0.002). 18/53 ABC teams (34%) and none of the 55 CAB teams (P = 0.006) applied more than the recommended two initial rescue breaths which caused a longer duration of the first cycle of 30 compressions and two ventilations in ABC teams (31 ± 13 vs.23 ± 6 sec; P = 0.001). Overall, the time to completion of the first resuscitation cycle was longer in ABC teams (63 ± 17 vs. 48 ± 10 sec; P <0.0001). CONCLUSIONS: This randomized controlled trial found CAB superior to ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.
- PublicationMétadonnées seulementBrief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: A randomized controlled trial(2010)
;Hunziker, Sabina ;Buhlmann, Cyrill
- PublicationMétadonnées seulementGroup research using high-fidelity experimental simulations(New York: Routledge, 2012)
; ;Semmer, Norbert K. ;Hunziker, SabinaMarsch, Stephan U