1673: Resuscitate Like a Champion: Nontechnical Skills and CPR Quality Improve With Simulation Program

Introduction: Errors in medicine are frequently due to inferior teamwork, leadership, and communication. Communication, leadership, and the principles of crisis resource management (CRM) have become the focus of team training, providing a framework for improving clinical performance during acute, life-threatening events. CRM principles encompass the following core constructs: leadership, teamwork, communication, problem-solving, resource utilization, and situational awareness. Methods: This is a single-center prospective, mixed-methods study that involved interprofessional pediatric cardiac arrest simulation and the development of a CRM program to improve nontechnical skills during pediatric cardiac arrest. Outcome measures included a validated checklist assessing knowledge, clinical skills, leadership, and communication, which was reviewed during simulation debriefs and subsequent video reviews of the resuscitation. Quantitative data collection included chest compression quality (depth, rate), chest compression fraction, time to first dose of epinephrine, and time to first defibrillation. A pre- and post-survey, as well as group interviews, were used to assess the CRM program. Results: Leadership, communication, and teamwork improved with the implementation of CRM program. Teams consistently demonstrated an increased incidence of closed-loop communication, shared mental model, situational awareness, the use of action-linked phrases, summarizing, asking for input, and showing mutual respect. The institution of the CPR coach role improved CPR metrics, including chest compression fraction (from 75 to 93%), target depth, rate, peri-shock pause (with an average reduction from 15 to 10 seconds), and time to defibrillation. Time to initial epinephrine dose and investigation of reversible causes was timely and more consistent. Conclusions: Improving nontechnical skills during pediatric cardiac arrest using the CRM framework and principles improves communication, leadership, and teamwork. More importantly, it leads to improved clinical performance during life-threatening events. Investigating the translation of these skill sets to real-life events is ongoing, and it informs the refinement of our CRM resuscitation program.