• Ville Peltonen, Laura-Maria Peltonen, Sanna Salanterä, Sanna Hoppu, Jaana Elomaa, Tomi Pappila, Eeva Hevonoja, Saija Hurme, Katariina Perkonoja, Teemu Elomaa, and Miretta Tommila.
• Anaesthesia and Intensive Care, Satakunta Hospital District, Sairaalantie 3, FI-28500 Pori, Finland; Department of Anaesthesiology and Intensive Care, University of Turku, P.O. Box 51, Kiinamyllynkatu 4-8, FI-20521, Turku, Finland; Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, P.O. Box 52, FI-20521 Turku, Finland. Electronic address: vhmpel@utu.fi.
• Resuscitation. 2020 Aug 1; 153: 162-168.

ObjectiveTechnical skills (TS) and non-technical skills (NTS) are the primary elements ensuring patient safety during advanced life support (ALS) and effective crisis resource management (CRM). Both skills are needed to perform high-quality ALS, though they are traditionally practiced separately. The evidence of the association between NTS and TS in high-quality ALS performance is insufficient. Hence, we aimed to evaluate the association between the skills in real-life in-hospital ALS situations.MethodsWe video recorded real-life in-hospital ALS situations, analyzed TS and NTS demonstrated in them with an instrument measuring TS and NTS, and tested the linear association between NTS and TS using a linear mixed model.ResultsAmong 50 real-life in-hospital ALS situations that we recorded, 20 had adequate data for analysis. NTS and TS total scores were associated with one another (slope 0.48, P < 0.001). All NTS subcategories were associated with the TS total score (slopes ranging from 0.29 to 0.39, P < 0.001). The NTS total score and TS subcategories (chest compression quality, ventilation quality, rhythm control and defibrillation quality) were associated with one another (slopes ranging from 0.37 to 0.56, P < 0.01).ConclusionsThe resuscitation teams who demonstrated good NTS also performed the technical aspects of ALS better. The results suggest that NTS and TS have an association with one another in real-life in-hospital ALS situations. NTS performance had the most evident association with chest compression quality and rhythm control and defibrillation quality; these are considered the most crucial elements affecting outcomes of ALS. The findings of the study present novel information of what and why to emphasize in ALS training.Clinical Trial RegistrationClinicalTrials.gov, NCT03017144.Copyright © 2020 Elsevier B.V. All rights reserved.

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