ECC Suggested Readings
September 2025
Duana McBride BVSc, MSc MVMedSc, DACVECC, DECVECC
I live in Hong Kong and am an Adjunct Professor at CityU Veterinary Medical Centre. I have an interest in how non-technical skills (e.g. communication, situation awareness, decision making) can improve patient outcomes. My recent move to Hong Kong has added the extra interesting challenge to my life as a criticalist with how cultural differences can impact decision making and patient care.
A paper that I recently liked…
An exploratory study on the effect of rescuer team size on basic and advanced life support technical skills in a high-fidelity simulation of canine cardiopulmonary arrest
Hoehne SN, Cary JA, Bailey LN, Davidow EB, Martin LG, DeJong TL
Paper Commentary
The study design
This study used 15 high-fidelity simulated events to determine the ideal number of participants during CPR. They randomised participants to group sizes of 4,6 and 8; and used videorecording for observation and quantitative analysis for analysing outcomes (e.g. time to BLS/ALS interventions).
The reason I was interested in this paper is the use of high-fidelity simulation in research. There are many benefits of using simulation in research in low frequency/high acuity events such as CPR. Simulation has the benefit of standardising events (minimising co-morbidities/variability), improve patient welfare (as the patients are manikins!) and improved psychological safety of participants. Another aspect of this study which I liked is student involvement as participants, which purpose was to standardise the experience of the participants, but the other benefit was that students got to be actively involved in research and got RECOVER trained.
The study background
Although a minimum number of rescuers is needed for BLS and ALS, this number is unknown in people or in veterinary hospitals. This is also an identified knowledge gap in the RECOVER initiative. Therefore, this study aimed to compare the effect of 3 different rescuer team sizes (4, 6, 8) on accomplishing BLS and ALS, and to minimise incompliant interventions (e.g. defibrillation in a non-shockable rhythm).
Study considerations
This study identified that interventions including time to first vasopressor administration, and fewest CPR guideline incompliance was observed in teams of 6, concluding that a rescuer size of 6 is most ideal. As the study states in the title, this is an exploratory study, meaning that they understand the limitation of the small sample size of 15 CPR events. With this in mind, it was interesting to observe that there were outcome measures which trended to but did not reach significant differences, including time to intubation, time to first compression, successful IV catheterisation in the 6/8 rescuer teams. Therefore, I contemplate if there would be significant differences if there was ideal sample size. The research group did perform a post hoc power analysis, which determined that an ideal sample size of 159 simulated CPR events would need to be conducted. I look forward to their results with this larger sample size in the future.
Takeaways
My main takeaway is that a rescuer size of 6 participants is ideal. Too little, may lead to delay in interventions (e.g. time to vasopressor administration), and too many can interfere with situation awareness and team communication. I have the benefit of working with a large team of certified rescuers, but if I had a smaller team, I would try to understand what interventions are limited by a small rescuer size, and how I can ensure that the specific intervention be timely (e.g. ease of access/administration vasopressor in the crash cart; early identification of dual roles for each rescuer). I hope you enjoy reading this paper too!
