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Standardising communication to improve in-hospital cardiopulmonary resuscitation

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  • Kasper Glerup Lauridsen
  • Ichiro Watanabe, Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA.
  • ,
  • Bo Løfgren
  • Adam Cheng, Department of Pediatrics, Division of Rheumatology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
  • ,
  • Jordan Duval-Arnould, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University Hospital, USA.
  • ,
  • Elizabeth A Hunt, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University Hospital, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Pediatric Hospital, USA.
  • ,
  • Grace L Good, Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA.
  • ,
  • Dana Niles, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.
  • ,
  • Robert A Berg, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.
  • ,
  • Akira Nishisaki, Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.
  • ,
  • Vinay M Nadkarni, Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.

AIM: Recommendations for standardised communication to reduce chest compression (CC) pauses are lacking. We aimed to achieve consensus and evaluate feasibility and efficacy using standardised communication during cardiopulmonary resuscitation (CPR) events.

METHODS: Modified Delphi consensus process to design standardised communication elements. Feasibility was pilot tested in 16 simulated CPR scenarios (8 scenarios with physician team leaders and 8 with chest compressors) randomized (1:1) to standardised [INTERVENTION] vs. closed-loop communication [CONTROL]. Adherence and efficacy (duration of CC pauses for defibrillation, intubation, rhythm check) was assessed by audiovisual recording. Mental demand and frustration were assessed by NASA task load index subscales.

RESULTS: Consensus elements for standardised communication included: 1) team preparation 15-30 s before CC interruption, 2) pre-interruption countdown synchronized with last 5 CCs, 3) specific action words for defibrillation, intubation, and interrupting/resuming CCs. Median (Q1,Q3) adherence to standardised phrases was 98% (80%,100%). Efficacy analysis showed a median [Q1,Q3] peri-shock pause of 5.1 s. [4.4; 5.8] vs. 7.5 s. [6.3; 8.8] seconds, p < 0.001, intubation pause of 3.8 s. [3.6; 5.0] vs. 6.9 s. [4.8; 10.1] seconds, p = 0.03, rhythm check pause of 4.2 [3.2,5.7] vs. 8.6 [5.0,10.5] seconds, p < 0.001, median frustration index of 10/100 [5,20] vs. 35/100 [25,50], p < 0.001, and median mental demand load of 55/100 [30,70] vs. 65/100 [50,85], p = 0.41 for standardised vs. closed loop communication.

CONCLUSION: This pilot study demonstrated feasibility of using consensus-based standardised communication that was associated with shorter CC pauses for defibrillation, intubation, and rhythm checks without increasing frustration index or mental demand compared to current best practice, closed loop communication.

Original languageEnglish
JournalResuscitation
Volume147
Pages (from-to)73-80
Number of pages8
ISSN0300-9572
DOIs
Publication statusPublished - 1 Feb 2020

    Research areas

  • Advanced life support, Communication, Delphi technique, In-hospital cardiac arrest, Nontechnical skills, Simulation

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