Individual and shared situational awareness in in-hospital cardiac arrest: insights from a real-world observational study.

Abstract

Background: Individual and shared situational awareness (SA) are crucial for team performance in high-pressure emergencies like cardiopulmonary resuscitation (CPR). While SA has been extensively studied in simulations, little research has examined its role in real-world in-hospital cardiac arrest (IHCA) settings. This study assessed individual and shared SA among medical emergency team (MET) members during CPR and explored its influence on team structure, communication and outcomes.

Methods: A cross-sectional observational study was conducted in real-world clinical settings, involving seven METs (n = 40). Individual SA was measured using the Situation Awareness Global Assessment Technique (SAGAT), while shared SA was assessed via a similarity index reflecting the alignment of team members' responses. Associations between SA, team structure, stress levels and clinical performance were analysed.

Results: Findings showed substantial variability in individual SA, with only 25% achieving full SA. Shared SA scores ranged from 0.95 ± 0.046 to 0.78 ± 0.144, with higher scores significantly associated with improved team structure (P = 0.034) and resuscitation success (P = 0.048). Mental work stress during CPR was linked to lower individual SA (P = 0.004), highlighting cognitive overload's impact on SA.

Conclusions: This study identifies critical SA gaps, affecting both individual performance and team coordination. Shared SA is a key predictor of resuscitation success and should be enhanced through structured SA training, high-frequency simulations and algorithm-driven protocols to improve team synchronisation, decision-making and patient outcomes in IHCA settings.