• Christopher James Groombridge, Yesul Kim, Amit Maini, Smit De Villiers V National Trauma Research Institute, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Monash University, Cent, and Mark Christopher Fitzgerald.
• National Trauma Research Institute, Melbourne, Australia; Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Monash University, Central Clinical School, The Alfred Centre, Melbourne, Australia. Electronic address: cgroombridge@doctors.org.uk.
• Resuscitation. 2019 Nov 1; 144: 115-122.

BackgroundDuring resuscitation decisions are made frequently and based on limited information in a stressful environment.AimThis systematic review aimed to identify human factors affecting decision-making in challenging or stressful situations in resuscitation. The secondary aim was to identify methods of improving decision-making performance under stress.MethodsThe databases PubMed, EMBASE and The Cochrane Library were searched from their commencement to the 13th of April 2019. MeSH terms and key words were combined (Stress* OR "human factor") AND Decision. Articles were included if they involved decision makers in medicine where decisions were made under challenging circumstances, with a comparator group and an outcome measure relating to change in decision-making performance.Results22,368 records in total were initially identified, from which 82 full text studies were reviewed and 16 finally included. The included studies ranged from 1995 to 2018 and included a total of 570 participants. The studies were conducted in several different countries and settings, with participants of varying experience and backgrounds. Of the 16 studies, 5 were randomised controlled trials, 3 of which were deemed to have a high risk of bias. The stressors identified were (i) illness severity (ii) socio-evaluative, (iii) noise, (iv) fatigue. The mitigators identified were (i) cognitive aids including checklists, (ii) stress management training and (iii) meditation.ConclusionsHuman factors contributing to decision-making during resuscitation are identified and can be mitigated by tailored stress training and cognitive aids. Understanding these factors may have implications for clinician education and the development of decision-support tools.Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.

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