Development and Evaluation of a Novel Resuscitation Teamwork Model for Out-of-Hospital Cardiac Arrest in the Emergency Department - 20/01/25
, Matthew Huei-Ming Ma, MD, PhD a, cAbstract |
Study objective |
Cardiopulmonary resuscitation (CPR) is critical for out-of-hospital cardiac arrest patients but is prone to rapid changes and errors. Effective teamwork and leadership are essential for high-quality CPR. We aimed to introduce the Airway-Circulation-Leadership-Support (A-C-L-S) teamwork model in the emergency department (ED) to address these challenges.
Methods |
The study comprised 2 phases. The development phase involved reviewing CPR videos, categorizing problems, and formulating strategies using the Systems Engineering Initiative for Patient Safety model. Resuscitation tasks were organized into A-C-L-S domains using hierarchical task analysis. Equipment and environmental deficits were optimized ergonomically with a pit-crew style arrangement. Mnemonics enhanced teamwork and leadership. The evaluation phase assessed postimplementation ED resuscitation team performance, focusing on adherence, timeliness, and quality of A-C-L-S tasks.
Results |
The development phase produced a structured teamwork model, assigning tasks, tools, mnemonics, and positions based on A-C-L-S domains. The A-team manages the airway and optimizes end-tidal CO 2 levels; the C-team focuses on high-quality chest compressions and defibrillation. Leadership coordinates resuscitation efforts using goal-directed mnemonics (DABCD 2 E 3 ), whereas the S-team handles medications, timekeeping, and recording. The evaluation phase showed improvements in adherence and timeliness of A-C-L-S tasks, with sustained increases in chest compression fraction before mechanical CPR, from 67.2% preimplementation to 83.0% postimplementation, 89.1% after 1 year, and 86.1% after 2 years. Overall, chest compression fraction also improved from 81.7% to 88.6%, peaking at 92.2% after 1 year and maintaining 90.8% after 2 years.
Conclusion |
The A-C-L-S teamwork model is feasible, applicable, and effective. Further research is needed to assess its influence on patient outcomes.
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| Please see page 164 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Peter C. Wyer, MD. Specific detailed information about possible conflicts of interest for individual editors is available at editors . |
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| Author contributions: KMC contributed to the conceptualization, methodology, data collection, statistical analysis, visualization, results interpretation, and manuscript writing. HCC was involved in conceptualization, methodology, and data collection. WCC contributed to conceptualization, methodology, and manuscript review. HCW, PCW, and MJS handled project administration and data collection. HYL managed project administration. CIK, WCL, CHH, CCF, and SCC provided supervision, with WCL also reviewing the manuscript. FB contributed to manuscript writing. CWY was responsible for conceptualization, methodology, results interpretation, manuscript writing, and supervision. Similarly, HMM contributed to conceptualization, methodology, results interpretation, manuscript writing, and supervision. KMC takes responsibility for the paper as a whole. |
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| Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request at cwyang0413@gmail.com . |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/ ). The authors deny any relationships. This study received support from grants from the National Taiwan University Hospital (NTUH 102-S2195) and the Taiwan National Science and Technology Council (MOST 103-2628-S-002-001-MY2). The funding source played no role in the design, execution, analysis, interpretation, or decision to submit the results of this study. |
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Vol 85 - N° 2
P. 163-178 - février 2025 Retour au numéro
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