College Answer

a)         The roles of the team leader include:

1)   Ensure  that  the  priorities  of  management  are  carried  out  effectively  and  efficiently.

Coordinate defibrillation, intubation cannulation and drug administration

2)   Help  establish  a  diagnosis  by  ECG  and  physical  examination  and  by  obtaining  all available history from hospital notes and bystanders.

3)   Check resuscitation status ( ?DNR) and prognosis

4)   Order investigations

5)   Reassess response to treatment

6)   Communicate with admitting consultant

7)   Ensure family is notified

8)   Organise post resuscitation care

b)         Priorities of cardiac arrest management may be best listed by drawing a sensible algorithm

(preferably AHA 2000 0r ILCOR 1999). The list should include

-     immediate basic life support

-     rapid rhythm diagnosis

-     defibrillation for VF, intubation/adrenaline for asystole or PEA

-     continued drug and defibrillation management

-     effective post –resuscitation care

Discussion

According to the ARC statement, the team leader is responsible for: 

• Directing and co-ordinating the resuscitation attempt 
• The safety of the resuscitation team at the cardiopulmonary arrest
• Ending the resuscitation attempt when indicated, often in consultation with other resuscitation team members and medical staff otherwise in charge of the patient
• Documentation (including audit forms) and for communication with the relatives and other healthcare professionals involved in the patient's management 
• Organising resuscitation team debriefing.

To this, one might add the following responsibilities:

• Assessing the rhythm and evaluating the need for defibrillation
• Ensuring the correct application of ALS and BLS
• Establishing a diagnosis for the cause of the arrest
• Ordering the appropriate investigations
• Ensuring minimal interruptions to CPR
• Allocating roles to the rescuers, and coordinating their efforts.
• Recruiting external resources (eg. cardiologists, ICU staff, cardiothoracic surgeons) into the resuascitation effort
• Communicating with family and the primary admitting consultant