Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: a randomised controlled trial

Objectives

To evaluate the impact of video-based interactive crisis resource management (CRM) training on no-flow time (NFT) and on proportions of team member verbalisations (TMV) during simulated cardiopulmonary resuscitation (CPR). Further, to investigate the link between team leader verbalisation accuracy and NFT.

Methods

The randomised controlled study was embedded in the obligatory advanced life support (ALS) course for final-year medical students. Students (176; 25.35 ± 1.03 years, 63% female) were alphabetically assigned to 44 four-person teams that were then randomly (computer-generated) assigned to either CRM intervention (n = 26), receiving interactive video-based CRM-training, or to control intervention (n = 18), receiving an additional ALS-training. Primary outcomes were NFT and proportions of TMV, which were subdivided into eight categories: four team leader verbalisations (TLV) with different accuracy levels and four follower verbalisation categories (FV). Measurements were made of all groups administering simulated adult CPR.

Results

NFT rates were significantly lower in the CRM-training group (31.4 ± 6.1% vs. 36.3 ± 6.6%, p = 0.014). Proportions of all TLV categories were higher in the CRM-training group (p < 0.001). Differences in FV were only found for one category (unsolicited information) (p = 0.012). The highest correlation with NFT was found for high accuracy TLV (direct orders) (p = 0.06).

Conclusions

The inclusion of CRM training in undergraduate medical education reduces NFT in simulated CPR and improves TLV proportions during simulated CPR. Further research will test how these results translate into clinical performance and patient outcome.