M. A. Vella1, R. Dumas1,2, K. Chreiman1, M. Subramanian1, M. Seamon1, P. Reilly1, D. Holena1 1University Of Pennsylvania,Traumatology, Surgical Critical Care And Emergency Surgery,Philadelphia, PA, USA 2University Of Texas Southwestern Medical Center,General And Acute Care Surgery,Dallas, TX, USA
Introduction: Teamwork and decision making are critical elements of trauma resuscitation. While assessment instruments such as the non-technical skills (NOTECHS) tool have been developed, correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT) as a model, we sought to describe the distribution of NOTECH scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC).
Methods: Continuously recording video was used to review all captured EDTs during the study period. We used a modification of the NOTECH instrument to measure 6 domains (leadership, cooperation/resource management, communication/interaction, assessment/decision making, situation awareness/coping with stress, and safety) on a 3-point scale (1 = best, 2 = average, 3 = worst). For each resuscitation, an overall total NOTECH (6-18 points) score was calculated. The primary outcome metric was ROSC. Associations between demographic, injury, and NOTECH variables and ROSC were examined using univariate regression analysis.
Results: 61 EDTs were captured during the study period. 19 patients had ROSC (31%) and 42 (69%) did not. The median NOTECH score for all the resuscitations was 9 [IQR 8-11]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model between NOTECH scores and ROSC. The association between overall NOTECH score and ROSC did not reach statistical significance, p=0.09, but examination of the individual components of the NOTECH score (Table 1) demonstrated that compared to resuscitations that had “average” (2) or “worst” (3) scores on “Assessment and Decision Making,” resuscitations with a “best” score were 5.3x more likely to lead to ROSC, p=0.017 (OR 5.3, CI 1.2-31.9).
Conclusion: While the association between overall NOTECH scores and ROSC did not reach statistical significance, assessment and decisions making did. In patients arriving in cardiac arrest who undergo EDT, better team performance is associated with improved rates of ROSC. Future analysis of the timing and quality of elements of resuscitation using video review may elucidate the mechanistic underpinnings of these findings.
