• Sabina Hunziker, Karen J O'Connell, Claudia Ranniger, Lillian Su, Seraina Hochstrasser, Christoph Becker, Daryl Naef, Elizabeth Carter, David Stockwell, Randall S Burd, and Stephan Marsch.
• Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland. Electronic address: Sabina.Hunziker@usb.ch.
• J Crit Care. 2018 Dec 1; 48: 72-77.

ObjectiveDuring cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied.MethodsThis randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance.ResultsWe included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams.ConclusionsWithin this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.Copyright © 2018 Elsevier Inc. All rights reserved.

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