Unravelling technical domain barriers and non-technical skill barriers among interprofessional teams during in-hospital cardiac arrest: a questionnaire-based survey

BACKGROUND: In spite of focused cardiopulmonary resuscitation (CPR) training, the in-hospital cardio-pulmonary resuscitation (CPR) performance often remains suboptimal, due to technical domain barriers and non-technical skill (NTS) barriers. We aimed to determine the technical domain and NTS barriers encountered by the in-hospital interprofessional (IP) CPR resuscitation teams through a cross-sectional, quantitative, analytical survey, and to determine whether a poor NTS score alone is associated with non-adherence to high-quality CPR. METHODS: A validated questionnaire was developed comprising 17 items on technical domain barriers and 9 on the NTS barrier domain. A web-based Likert-scale questionnaire was administered to assess perception-based barriers among 400 IP team members across healthcare settings in India, focusing on technical domain barriers and NTS domain barriers. IP members with at least 1 year of work experience, hands-on CPR training, and in-hospital CPR experience were recruited. RESULTS: There were 32.75% doctors, 29.75% nurses, 24% respiratory therapists, 10.25% emergency technicians, and 2.25% ICU technicians. The logistic regression analysis revealed that only five items independently predicted a poor technical domain score: inability to identify cardiac rhythm, non-working defibrillator, unavailability of a supraglottic airway device, unavailability of a correct-size laryngoscope blade, and a delay in loading medications. Five NTS items independently predicted a poor NTS score: lack of clear instructions from the team leader, lack of awareness of the dynamic nature of resuscitation, lack of closed-loop communication, lack of assigned tasks completed by a team member, and lack of knowledge sharing among team members. A poor NTS score is associated with perceived non-adherence to high-quality CPR (Chi-Square test, p-value < 0.001). CONCLUSION: Both NTS barriers and technical domain barriers were associated with perceived non-adherence to high-quality CPR. TRIAL REGISTRATION: Clinical Trial Registry of India CTRI/2025/05/086727 registered on 13/05/2025.