Le rôle de la coordination d'équipe adaptative pendant la réanimation cardio-pulmonaire = : The Role of Adaptive Team Coordination during Cardiopulmonary Resuscitation

Authors: Kramer, Chelsea
Advisor: Tremblay, Sébastien
Other Title(s): Role of Adaptive Team Coordination during Cardiopulmonary Resuscitation
Abstract: In-hospital cardiac arrest affects over 200,000 patients in North America each year, but less than 25% of patients survive to hospital discharge. When a patient’s arrhythmic heart is unable to effectively circulate blood, a team of rescuers provide lifesaving interventions according to Cardiopulmonary Resuscitation (CPR) rescue algorithms. Since the inception of the American Heart Association (AHA) CPR guidelines over 30 years ago, research pursuits to improve survival rates have primarily focused on the technical tasks such as CPR technique. Over the past decade, there has been increased focus on team performance related to treatment delays and CPR quality, touting ineffective coordination and teamwork as some of the largest obstacles to successful team resuscitation. The objective of this work was to validate a proposed framework outlining the relationship among explicit and implicit coordination mechanisms required for successful CPR performance: minimal interruptions (hands-off ratio), rapid initiation of chest compressions and defibrillation. The framework was tested in two independent studies of simulated adult and pediatric resuscitation of in-hospital cardiac arrest. The results showed that while team performance improved over time, the main Explicit and Implicit coordination type patterns were stable. Instead, small shifts occurred within the Information and Action coordination sub-types. Explicit coordination was dominant throughout all resuscitation scenarios, but only Implicit coordination was associated with better hands-off ratio performance. In both studies, higher performing teams coordinated differently than lower performing teams and there was a significant relationship between the patterns of coordination mechanisms and CPR performance. The combined results are used to refine a proposed coordination framework for acute resuscitation care and propose practical implications for CPR training and methodological contribution for future research.
Document Type: Thèse de doctorat
Issue Date: 2019
Open Access Date: 24 September 2019
Permalink: http://hdl.handle.net/20.500.11794/36613
Grantor: Université Laval
Collection:Thèses et mémoires

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