Effects of team leaders' position in cardiopulmonary resuscitation teams on leadership behavior and team performance: A prospective randomized interventional cross-over simulation-based trial

Background:Leadership is an important performance factor in resuscitation teams. Medical guidelines for cardiopulmonary resuscitation (CPR) advise team leaders to keep hands off patients. There is little evidence for this recommendation that is based purely on observational data. Accordingly, the aim of this trial was to investigate the effect of leaders' position during CPR on leadership behavior and team performance. Method:This is a prospective randomized interventional crossover simulation-based single center trial. Teams of 3 to 4 physicians each, representing a rapid response team, were confronted with a simulated cardiac arrest. Team leaders were randomly assigned and assigned team leaders were 1:1 randomized to 2 leadership positions: position at the patient's head; and hands-off position. Data analysis was performed from video-recordings. All utterances during the first 4 minutes of CPR were transcribed and coded based on a modified "Leadership Description Questionnaire." The primary endpoint was the number of leadership statements. Secondary outcomes included CPR related performance markers like hands-on time and chest compression rate, and the behavioral related endpoints Decision Making, Error Detection, and Situational Awareness. Results:Data from 40 teams (143 participants) was analyzed. Leaders in hands-off position made more leadership statements (28 & PLUSMN; 8 vs 23 & PLUSMN; 8; P <.01) and contributed more to their team's leadership (59 & PLUSMN; 13% vs 50 & PLUSMN; 17%; P = .01) than leaders in the head position. Leaders' position had no significant effect on their teams' CPR performance, Decision Making, and Error Detection. Increased numbers of leadership statements lead to improved hands-on time (R = 0.28; 95% confidence interval 0.05-0.48; P = .02). Conclusions:Team leaders in a hands-off position made more leadership statements and contributed more to their teams' leadership during CPR than team leaders actively involved in the head position. However, team leaders' position had no effect on their teams' CPR performance.