Nontechnical Skills and Leadership Are Associated With More Efficient Mechanical Cardiopulmonary Resuscitation Deployment in Real‐World Cardiac Arrest

Background Mechanical cardiopulmonary resuscitation (MCPR) devices provide consistent compressions, yet guidelines discourage routine use partly because deployment can increase no‐flow time. Although nontechnical skills improve manual CPR performance, their association with deployment safety during MCPR remains unclear. This study examined the association between nontechnical skills and cumulative no‐flow time during MCPR deployment in real‐world resuscitations. Methods We conducted a prospective observational study of video‐recorded cardiac arrest events in a tertiary emergency department. NTS were assessed by trained raters using the Team Emergency Assessment Measure (TEAM). The primary outcome was the association between TEAM scores and cumulative no‐flow time during deployment, analyzed with multivariable linear mixed‐effects models adjusted for patient characteristics and team leader clustering. Secondary outcomes included MCPR deployment duration and other technical intervals. Results Eighty‐five eligible MCPR cases were analyzed. For each 1‐point increase in TEAM global rating, cumulative no‐flow time was 6 seconds shorter (95% CI, −10 to −1; P =0.009). Higher TEAM global rating was also associated with shorter MCPR deployment duration (−20 seconds; P =0.003) and earlier intravenous line placement (−43 seconds; P =0.011). Leadership was the only TEAM subdimension significantly associated with cumulative no‐flow time ( P =0.010). Conclusions Higher nontechnical skills ratings, particularly leadership, were associated with shorter cumulative no‐flow time and greater operational efficiency during MCPR deployment. These findings support an association between team nontechnical performance and deployment efficiency in real‐world mechanical resuscitation.