An exploratory study on the effect of rescuer team size on basic and advanced life support technical skills in a high-fidelity simulation of canine cardiopulmonary arrest.

Abstract

OBJECTIVE: To evaluate the effect of rescuer team size on objective skill measures of basic life support (BLS) and advanced life support (ALS) using high-fidelity canine CPR simulation. DESIGN: Prospective, experimental study. SETTING: Veterinary clinical simulation center. SUBJECTS: Forty-eight Reassessment Campaign on Veterinary Resuscitation CPR-certified veterinary students. MEASUREMENTS AND MAIN RESULTS: Five groups of participants each conducted 3 CPR simulations in configurations of 4, 6, and 8 rescuers. Simulations represented a shock patient declining into asystole, followed by ventricular fibrillation and return of spontaneous circulation. Resuscitation efforts were video-recorded to evaluate BLS and ALS tasks. Mean (&#xb1;SD) was derived and data were compared among team sizes using ANOVA and Tukey's post hoc analysis. Significance was set at P&#xa0;<&#xa0;0.05. Among teams of 4, 6, and 8 rescuers, time to first chest compression (13&#xa0;s [&#xb1;6], 9&#xa0;s [&#xb1;2], 8&#xa0;s [&#xb1;4]; P&#xa0;=&#xa0;0.24) and positive-pressure breath (101&#xa0;s [&#xb1;37], 56&#xa0;s [&#xb1;15], 67&#xa0;s [&#xb1;24]; P&#xa0;=&#xa0;0.05) were not significantly different. Chest compression (100/min [&#xb1;5], 108/min [&#xb1;6], 107/min [&#xb1;6]; P&#xa0;=&#xa0;0.12) and ventilatory rates (9/min [&#xb1;1], respectively, P&#xa0;=&#xa0;0.52) were not significantly different. Time without chest compressions/total length of CPR was not significantly different (72&#xa0;s [&#xb1;16], 61&#xa0;s [&#xb1;16], 54&#xa0;s [&#xb1;8]; P&#xa0;=&#xa0;0.15). Capnography and ECG monitoring were used by all teams. Time to first vasopressor administration was significantly different among team sizes (268&#xa0;s [&#xb1;70], 164&#xa0;s [&#xb1;65], 174&#xa0;s [&#xb1;34]; P&#xa0;=&#xa0;0.04), with vasopressors being most quickly administered by teams of 6 rescuers. Time to electrical defibrillation was not significantly different (486&#xa0;s [&#xb1;45], 424&#xa0;s [&#xb1;22], 488&#xa0;s [&#xb1;181]; P&#xa0;=&#xa0;0.57). Incorrect ALS interventions occurred in 60%, 0%, and 40% of CPR events in 4, 6, and 8 rescuer teams, respectively. CONCLUSIONS: Although the achievement of BLS tasks was comparable in teams of 4 rescuers, teams of 6 rescuers may be preferable based on differences in the rate of guideline-incompliant treatments and ALS task efficiency. Teams of 8 rescuers were neither more efficient nor more accurate at conducting BLS and ALS tasks.