Unethical leadership can lower the quality in resuscitation teams: a randomized simulation study.

Objective: The aim of this study was to evaluate whether verbal pressure from the team leader distracted students during a critical care simulation scenario. Particularly, examining the influence of unethical leadership on CPR quality was the objective of this work. Methods: Eighty students were randomized into study (n=40) and control group (n=40). They participated in a short cardiac arrest simulation scenario, each one separately. The scenario consisted of two tasks. Firstly, they were asked to bring to the team leader one ampule of a particular drug. A variety of drugs in their original packaging were placed on a shelf, but the handicap of this task was that the ampullae were mixed up between boxes. The second task was to perform 30 good-quality chest compressions. Study group participants were experiencing verbal pressure during the first part. Results: Study group participants fulfil the first task faster (require less time to bring the ampulla), but fewer of them find out that medications are mistaken (in comparison with the control group). Moreover, the study group reports higher stress levels (as assessed in 1 - 10 scores), and more participants perform too fast chest compressions (faster than 120 times per minute) in this group. Conclusion: Verbal pressure from a team leader increases participants' stress levels and decreases their effectiveness (chest compression quality and the ability to identify that ampullae are mistaken).