Improved recognition of ineffective chest compressions after a brief Crew Resource Management (CRM) training: a prospective, randomised simulation study

Abstract

Background: Chest compressions are a core element of cardio-pulmonary resuscitation. Despite periodic training, real-life chest compressions have been reported to be overly shallow and/or fast, very likely affecting patient outcomes. We investigated the effect of a brief Crew Resource Management (CRM) training program on the correction rate of improperly executed chest compressions in a simulated cardiac arrest scenario.

Methods: Final-year medical students (n = 57) were randomised to receive a 10-min computer-based CRM or a control training on ethics. Acting as team leaders, subjects performed resuscitation in a simulated cardiac arrest scenario before and after the training. Team members performed standardised overly shallow and fast chest compressions. We analysed how often the team leader recognised and corrected improper chest compressions, as well as communication and resuscitation quality.

Results: After the CRM training, team leaders corrected improper chest compressions (35.5%) significantly more often compared with those undergoing control training (7.7%, p = 0.03*). Consequently, four students have to be trained (number needed to treat = 3.6) for one improved chest compression scenario. Communication quality assessed by the Leader Behavior Description Questionnaire significantly increased in the intervention group by a mean of 4.5 compared with 2.0 (p = 0.01*) in the control group.

Conclusion: A computer-based, 10-min CRM training improved the recognition of ineffective of chest compressions. Furthermore, communication quality increased. As guideline-adherent chest compressions have been linked to improved patient outcomes, our CRM training might represent a brief and affordable approach to increase chest compression quality and potentially improve patient outcomes.

Keywords: Cardiopulmonary resuscitation; Communication; Crew resource management; Emergency medicine; Healthcare; Hospital rapid response team; Simulation training.

Fig. 1

Study design (CONSORT) [23] flow diagram. Sixty participants were recruited. Three participants were excluded from data analysis for the following reasons: lack of blinding (n = 1), incomplete scenario (n = 1), and lack of comprehension (n = 1). The participants drew an envelope for random assignment to each group. This resulted in the randomisation of 31 participants to the intervention group and 26 participants to the control group

Fig. 2

Assessment of the standardisation for compression depth by the tutor. a. Correct compression depth: Median (Q25–Q75): 55 (55–60) mm, n = 51; incorrect compression depth: 30 (30–40) mm, n = 51; and compression rate (b). Correct frequency: 110 (105–110) bpm, n = 51 and incorrect frequency: 140 (135–140) bpm; n = 51 (Box-plot). Before every resuscitation scenario, the tutors performed the correct and the incorrect execution of the chest compressions separately. The hatched area highlights the reference range of the European Resuscitation Council Guidelines 2015 (50–60 mm and 100–120 bpm)

Fig. 3

a The total Leader Behavior Description Questionnaire (LBDQ) score for the pre- and post-measurement (boxplot). b While the mean difference (median pre/post) in the ethics group is 2.0 (20.0/21.5), it is 4.5 (19.5/24.5) in the CRM group

Fig. 4

Pie diagram of each group and the pre- (a) and post-measurement stages (b) for ethics (left) and CRM groups (right). The shaded parts represent the scenarios in which an error was corrected. The white area represents scenarios where neither the compression rate nor the compression depth was corrected. a Ethics: compression rate corrected 7.7% (n _{of corrections (oc)} = 2), total: 7.7% (n_oc = 2), n = 26; CRM: compression depth corrected in 3.2% (n_oc = 1), both mistakes corrected in 6.5% (n_oc = 2), total: 9.7% (n_oc = 3), n = 31. b Ethics: compression rate corrected in 7.7% (n_oc = 2), total: 7.7% (n_oc = 2), n = 26; CRM: compression depth corrected in 12.9% (n_oc = 4), compression rate corrected in 9.7% (n_oc = 3), both mistakes corrected in 12.9% (n_oc = 4), total 35.5% (n_oc = 11), n = 31

Fig. 5

Average chest compression quality during the resuscitation (scatter plot). a, c Mean compression depth of the resuscitations. The points indicate one resuscitation each, where no correction of the compression depth was applied. A triangle mark shows the average compression depth of the resuscitation after the participant corrected the tutor. b, d Average compression rates. The triangle indicate that a correction of the compression rate has been applied and the average was calculated based on this correction. a Ethics: Median (Q25–Q75) 37.0 (31.0–39.0) mm; CRM: 34.0 (31.0–37.00 mm) b Ethics: 142.0 (137.0–145.0) bpm; CRM: 141.0 (137.25–146.75) bpm c Ethics: 36.0 (33.5–41.5) mm; CRM: 37.5 (33.0–54.25) mm d Ethics 143.0 (133.5–150.0) bpm; CRM: 137.5 (115.0–146.5) bpm