Effectiveness of a multidisciplinary "crisis checklist" on nursing performance during intraoperative cardiac arrest:...

Intraoperative cardiac arrest (IOCA) is a high-acuity surgical crisis demanding flawless execution of technical and behavioral skills. Traditional crisis management often lacks structured, nursing-specific cognitive tools, leaving teams vulnerable to fixation errors and communication breakdown under stress. The objectives of the study were to determine whether a structured multidisciplinary crisis checklist improves critical resuscitation timelines, nursing performance adherence, behavioral teamwork dynamics, and provider subjective stress mitigation during simulated IOCA events. This prospective, comparative cohort study evaluated 40 operating room teams (N = 120 healthcare professionals: anesthesiologists, scrub nurses, and circulating nurses) sequentially allocated to either the Multidisciplinary Checklist group (MC; n = 20 teams) or the Standard Resuscitation group (SR; n = 20 teams) following traditional Advanced Cardiovascular Life Support (ACLS) guidelines. Teams managed a standardized intraoperative ventricular fibrillation scenario. Outcome parameters included a novel, validated Nursing Performance Adherence Score (NPAS), time-to-critical-interventions, Mayo High Performance Teamwork Scale (MHPTS) scores, and provider subjective stress levels mapped via a 10-point Visual Analog Scale. The team was designated as the primary unit of analysis. Total NPAS was significantly superior in the MC group compared to the SR group (9.25 ± 0.79 vs. 6.4 ± 1.43, p < 0.001), correlating tightly with checklist utilization (R = 0.86, p < 0.001). For critical technical workflows, the MC group achieved an 8.4-fold higher probability of rapid epinephrine delivery, decreasing median administration time by 51 s (143.5 s vs.194.5 s; Hazard Ratio = 8.42, Log-rank, p < 0.001). Teamwork quality was significantly enhanced in the MC group, yielding superior total MHPTS scores (28.60 ± 1.96 vs. 22.30 ± 3.31, p < 0.001). Subjective provider stress levels were significantly reduced via checklist implementation (p < 0.001). Integrating a structured multidisciplinary crisis checklist into simulated IOCA workflows significantly accelerates life-saving interventions, optimizes nursing task execution, alleviates clinician stress, and ensures high-performance team collaboration. These empirical simulation findings strongly support the implementation of specialized emergency manuals in perioperative safety training.