Resuscitation team leadership and crisis resource management

The resuscitation is not a series of clinical decisions made by a single clinician; it is a team operation in which the non-technical skills — the leadership, communication, resource management, and the situational awareness — are as important to the outcome as the clinical knowledge. The formal study of these skills, the crisis resource management, began in the aviation industry after the recognition that most aeroplane crashes were caused not by mechanical failure but by failures of the crew's communication, the leadership, and the decision-making under stress. The translation of these principles to medicine, and to the resuscitation in particular, is the subject of the ILCOR Education, Implementation and Teams consensus, and it is now an explicit domain of the Fellowship examination.^[1]

Team roles in resuscitation

The resuscitation team has allocated roles, each with a defined responsibility, and the allocation is made at the start of the resuscitation, before the need for it arises. The team leader stands back and directs the team, the airway operator manages the airway and the ventilation, the compressor performs the chest compressions (rotated every two minutes in the arrest), the defibrillator operator manages the rhythm analysis and the shocks, the drugs operator prepares and gives the drugs, the timekeeper and scribe records the interventions and the cycle times, and the runner fetches the equipment and the blood products.^[1]

References12ShowHide

1. [1]Greif R, Bhanji F, Bigham BL, et al. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Resuscitation, 2020.PMID 33098918
2. [2]Farquharson B, Cortegiani A, Lauridsen KG, et al. Teaching team competencies within resuscitation training: A systematic review Resusc Plus, 2024.PMID 39006135
3. [3]Gaba DM. Crisis resource management and teamwork training in anaesthesia Br J Anaesth, 2010.PMID 20551023
4. [4]Edelson DP, Litzinger B, Arora V, et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing Arch Intern Med, 2008.PMID 18504334
5. [5]Bajaj K, Meguerdichian M, Thoma B, et al. The PEARLS Healthcare Debriefing Tool Acad Med, 2018.PMID 29381495
6. [6]Anderson TM, Secrest K, Krein SL, et al. Best Practices for Education and Training of Resuscitation Teams for In-Hospital Cardiac Arrest Circ Cardiovasc Qual Outcomes, 2021.PMID 34779653
7. [7]Cooper S, Cant R, Porter J, et al. Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM) Resuscitation, 2010.PMID 20117874
8. [8]Cooper S, Connell C, Cant R. Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review Emerg Med Australas, 2023.PMID 36849717
9. [9]Fung L, Boet S, Bould MD, et al. Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: A systematic review J Interprof Care, 2015.PMID 25973615
10. [10]Alsabri M, Boudi Z, Lauque D, et al. Impact of Teamwork and Communication Training Interventions on Safety Culture and Patient Safety in Emergency Departments: A Systematic Review J Patient Saf, 2022.PMID 33890752
11. [11]Cheng A, Eppich W, Epps C, et al. Embracing informed learner self-assessment during debriefing: the art of plus-delta Adv Simul (Lond), 2021.PMID 34090514
12. [12]Kainth R. Dynamic Plus-Delta: an agile debriefing approach centred around variable participant, faculty and contextual factors Adv Simul (Lond), 2021.PMID 34620251