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Randomized Controlled Trial
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Effect of CRM Team Leader Training on Team Performance and Leadership Behavior in Simulated Cardiac Arrest Scenarios: A Prospective, Randomized, Controlled Study

Randomized Controlled Trial

Effect of CRM Team Leader Training on Team Performance and Leadership Behavior in Simulated Cardiac Arrest Scenarios: A Prospective, Randomized, Controlled Study

Ezequiel Fernandez Castelao et al. BMC Med Educ.


Background: 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.

Methods: 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).

Results: 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).

Conclusion: 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.


Fig. 1
Fig. 1
Flow Diagram of study design and sample sizes (Consort). Dotted line represents non-leading members of teams allocated to the CRM-TL group. They completed ALS add-on training before data acquisition

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    1. Tschan F, Semmer NK, Hunziker S, Kolbe M, Jenni N, Marsch SU. Leadership in different resuscitation situations. Trends Anaesth Crit Care. 2014;4:32–36. doi: 10.1016/j.tacc.2013.12.001. - DOI
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