It Starts and Ends with Resuscitation (Crisis Resource Management in Intensive Care)

Ivie D. Esangbedo, MD, MPH
Associate Editor, PCICS Newsletter
Assistant Professor of Pediatrics
UT Southwestern Medical Center, Dallas, Texas
Division of Critical Care Medicine, Cardiac Intensive Care

Ivie D. Esangbedo, MD, MPH
Ivie D. Esangbedo, MD, MPH

I joined the PCICS Connections Committee in 2018, as one of two new Associate Editors of the PCICS Newsletter. I was delighted to be tasked with putting together the Spring 2019 Newsletter. We decided to have a theme for this edition of the newsletter: Cardiac Arrest and Cardiopulmonary Resuscitation. My academic interest is in resuscitation science research and quality improvement – a passion discovered and fueled by being in the right place at the right time, being offered a great opportunity and being inspired by wonderful mentors.

As I have delved more into resuscitation work, I have often found myself pondering the human factors that affect resuscitation. A previously healthy toddler presents to your emergency department with myocarditis, and suddenly hits your ICU doorstep on a weekend evening – pale, in ventricular tachycardia with thready pulses, without an endotracheal tube and with barely one peripheral IV catheter. Within minutes, the scenario is E-CPR. Is your team ready?

A lot of collective energy is spent training intensive care unit (ICU) teams for medical emergencies – basic life support, advanced life support, simulation - and yet unexpected real-life events always seem to present different challenges. The forces of tension, emotion, and adrenaline are not fully accounted for during simulation. Do team members fall into their roles smoothly? What is communication like in the first few minutes of CPR? Do team members know each other by first name? Though we spend a lot of time improving knowledge base and procedural skills, comparatively less time is spent preparing teams to accommodate and mitigate human/psychological factors such as fear, anxiety, sadness, pride, etc. – all of which can affect recall memory, working memory, coordination, judgement, awareness and communication.

Crisis Resource Management (CRM) refers to non-clinical and non-technical skills required for effectively managing a crisis: leadership, situational awareness, team management, task management, dynamic decision-making, communication and interpersonal behavior. These are just as important as the clinical and technical skills, but are more difficult to teach. Is 'experience' the most important determinant? Perhaps. But adjunctive techniques to traditional simulation hold some key, e.g. use of a code room map, use of name-role tags, dedicated resuscitation teams, and effective debriefing of every event.

We have fantastic contributions for this Spring 2019 Newsletter. The Guest Editorial is written by Dr. Tia Raymond, a cardiac intensivist and resuscitation scientist who has contributed immensely to the literature in resuscitation and has done extensive work with the American Heart Association (AHA) Emergency Cardiovascular Care (ECC) Committee and the Pediatric Cardiac Critical Care Consortium (PC⁴). The Early Career Editorial contribution comes from Dr. Javier Lasa, also a cardiac intensivist, who is advancing his work in researching extracorporeal life support and cardiopulmonary resuscitation. In addition, Christine Riley – a nurse practitioner in cardiac intensive care who has significant interest in nursing contributions to resuscitation – authored the Nursing Editorial.

We have a very informative message from the President, Dr. John Costello, as well as updates from these PCICS committees:

  1. Education committee
  2. Research committee
  3. APP Curriculum committee
  4. Special Interest Group – Administration
  5. Special Interest Group – Clinical Nurse Specialist/Educator

We are looking forward to the next PCICS Joint Paediatric Critical Care International Meeting, which will be the third meeting to be held outside the United States. The conference this year will be in London, UK in November. Abstract submissions for this London conference are open already. Now is the time to start working to ensure that your travel documents (passports +/- visas) are ready! Surely, you wouldn’t want to miss out on scotch eggs and fish and chips, as well as a prime view of Brexit.

The PCICS podcast is now released monthly, so look out for new episodes in the first week of every month. The PCICS newsletter is released quarterly. Please email any suggestions or proposed editorials, opinions, or content to
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