Ideal Composition of an Advanced Cardiovascular Life Support (ACLS) Team
The ideal ACLS team should consist of six members with clearly defined roles: a team leader, a compressor, an airway manager, a medication administrator, a defibrillator operator, and a recorder/timekeeper, with all members having ACLS certification and specific training for their roles. 1
Core Team Structure and Roles
Required Team Members:
- Team Leader: Typically a physician or experienced advanced provider who directs the resuscitation efforts, makes treatment decisions, and coordinates team activities
- Compressor: Responsible for delivering high-quality chest compressions (100-120/min, at least 2 inches deep)
- Airway Manager: Manages ventilation and advanced airway placement (typically an anesthesiologist, respiratory therapist, or trained provider)
- Medication Administrator: Usually a nurse or pharmacist who prepares and administers medications
- Defibrillator Operator: Manages the defibrillator, applies pads, and delivers shocks when directed
- Recorder/Timekeeper: Documents interventions, medications, and timing of events
Team Qualifications and Training
All ACLS team members must have:
- Current ACLS Provider certification 1
- Regular simulation-based training and mock codes 1
- Clear understanding of crisis resource management principles 1
- Experience with their specific role responsibilities
The American Heart Association guidelines specifically state that "code team members must have ACLS Provider cards and be on duty in the hospital and available to respond to codes at all times." 1
Team Communication and Coordination
Effective team function depends on:
- Clear, closed-loop communication
- Predefined roles with minimal role confusion
- Regular team training using simulation-based scenarios 2
- Structured debriefing after resuscitation events 1
Research shows that teams with at least one member having completed an accredited ACLS course have higher rates of return of spontaneous circulation (odds ratio, 1.64; 95% CI, 1.12–2.41) and improved survival to hospital discharge (odds ratio, 2.43; 95% CI, 1.04–5.70) 1.
Team Experience Considerations
Team effectiveness is directly related to experience:
- Teams with more than 6 cardiac arrest exposures in the preceding 3 years show improved survival outcomes 1
- Teams with 17+ exposures demonstrate a 50% higher adjusted odds ratio for survival (1.50; 95% CI, 1.22–1.86) 1
- Regular mock codes and simulation training can help maintain skills between actual events 2
Special Considerations
Maternal Cardiac Arrest
For pregnant patients, the team should be expanded to include:
- Obstetric provider
- Neonatal resuscitation team member
- Additional personnel for lateral uterine displacement 1
COVID-19 or Infectious Disease Scenarios
Additional considerations include:
- Team members must don appropriate PPE before entering the room
- Minimize personnel in the room
- Use HEPA filters on all ventilation equipment 1
Common Pitfalls to Avoid
- Role confusion: Clearly define and communicate roles before and during resuscitation
- Inadequate training: Ensure all team members maintain current ACLS certification
- Poor communication: Practice closed-loop communication during simulations
- Infrequent practice: Schedule regular mock codes to maintain skills
- Team leader inexperience: Ensure team leaders receive specific training in crisis resource management 3
Implementation Recommendations
- Establish a standardized method for team activation (e.g., hospital-wide public address system) 1
- Use just-in-time training before shifts to refresh skills 1
- Implement performance-focused debriefing after resuscitation events 1
- Ensure standardized equipment across all hospital locations 1
- Consider using information systems to guide the ACLS process and document interventions 4
The evidence clearly demonstrates that a well-structured, properly trained six-member ACLS team with clearly defined roles significantly improves patient outcomes in cardiac arrest situations.