The Cardiac Arrest Nurse Leadership (CANLEAD) Trial: Does the implementation of a new cardiac arrest role facilitate cognitive offload for medical team leaders

Mr Jeremy Pallas1, Dr John Paul Smiles, Dr Michael  Zhang

1Nsw Health, Newcastle, Australia

Introduction: Optimal resuscitation for patients suffering cardiac arrest necessitates an efficient team approach. Historically, medical team leaders have been subject to disproportionately high cognitive burden that prevails in such complex and stressful resuscitation events.

Objective: This study aimed to explore whether the implementation of a new “Nursing Team Leader” role is an effective way of providing cognitive offload for the medical team leader in a cardiac arrest scenario.

Methods:  This randomised controlled trial used a series of point of care simulations run in the emergency departments of the John Hunter and Maitland Hospitals. Both medical and nursing participants were randomised to either Control (traditional team roles) or Intervention (prescribed nursing team leader) groups – each group was balanced with 6 participants. The Nursing team leader in the Intervention group had a pre-determined set of designated resuscitation tasks. Debriefing data was collected for thematic analysis and a quantitative evaluation of both task efficiency and self-reported cognitive load was attended using a video assisted ‘task time checklist’ and the NASA Task Load Index.

Results: A total of 20 cardiac arrest simulations with equal distribution in Control and Intervention groups were evaluated (totalling 120 participants). While there was no statistically significant improvement in perceived performance among participants in this study, the nursing team leader role was associated with significant cognitive offload for medical team leaders. The intervention groups were also able to perform numerous tasks more efficiently than the control including the timely application of the defibrillator, rapid assessment for reversible causes and management of CPR quality.

Conclusion: The incorporation of a dedicated nursing team leader role focused on the facilitation of high quality advanced life support is a practical and effective means of both facilitating cognitive offload for medical team leaders and improving general task efficiency in the setting of cardiac arrest.


Jeremy Pallas is currently working as the Clinical Nurse Consultant in the Emergency Department of the John Hunter Hospital. He has a keen interest in contemporary resuscitation with a focus on Acute Heart Disease and Trauma. Jeremy is passionate about the continual evolution of the modern emergency nurse and has a strong belief in the value of a well-educated and well supported clinician. Jeremy is also a simulation educator working in the Hunter New England Simulation Centre to facilitate and instruct on a number of different emergency training courses.