Something was not right.
The patient’s hands and feet were cool to the touch, and the pulses were thready. As we watched the monitors, the heart rate slowed and the blood pressure fell. Within moments, we were giving an intravenous fluid bolus. Despite the intervention, both the heart rate and blood pressure continued to fall.
The team moved quickly. We gave a code dose of epinephrine and started cardiopulmonary resuscitation (CPR). Fortunately, our efforts were successful. The patient stabilized and returned to baseline.
When the Room Grew Quiet
But, the team was shaken.
What happened? Did we miss something? What did we do well? What could we have done differently? Was everyone okay?
The questions were not spoken immediately, but they were visible on the faces around the room. It was time for us to talk. It was time to debrief.
I am not a therapist, social worker, or mental health professional. But, I am a leader. I had served as the code captain, and my responsibility did not end when the patient stabilized. I was responsible not only for the patient, but also for the team that had cared for that patient.
After an event like this, people need space to process what happened. We also needed to examine the clinical course while the details were still fresh. Could the deterioration have been recognized earlier? Could the need for CPR have been prevented? What had worked well? Where had our systems made the work harder?
Learning Without Blame
Once the immediate demands of the event had settled, I gathered the people who had participated in the code. We stepped away from the clinical activity and found a private place to talk. The purpose was not to assign blame. It was to check on one another, understand what had happened, and identify ways to improve.
Despite the intensity of the event, the group was calm and thoughtful. This was not indifference. It was the measured reflection of a seasoned, battle-tested team. No one was singled out. Physicians, nurses, respiratory therapists, pharmacists, and others all had an opportunity to speak.
The discussion was candid and productive. We identified systems-level gaps and proposed solutions. The resuscitation had been successful, but no one treated success as proof that there was nothing left to learn. The question that kept surfacing was simple: How could we do better?
That response stayed with me. The team had just helped resuscitate a child, yet the instinct in the room was not self-congratulation. It was curiosity. Every person wanted to understand the event more clearly and make the next response even better.
In critical care, unexpected deterioration can never be eliminated entirely. Our patients are vulnerable due to their critical illness, and their conditions can change quickly. Our task is to anticipate risk, recognize change early, respond effectively, and learn honestly afterward.
The conversation we held soon after the event is often called a “hot debrief”, a structured discussion conducted while the experience is still fresh. Its purpose is not formal psychological treatment. It is an immediate opportunity to support the team, review clinical and operational factors, and capture lessons that might otherwise fade with time. Current resuscitation guidance places ongoing debriefing and quality improvement within an effective system of cardiac arrest care.(1)
Research also suggests that post-event debriefing is valued for reflection, teamwork, and learning, even though time, staffing, and inconsistent processes can make it difficult to perform reliably.(2) Feedback studies have likewise shown that reviewing resuscitation performance may improve elements of CPR quality, although those findings should not be stretched into claims that every debrief directly improves patient outcomes.(3)
Two Truths at Once
As the team talked, I realized that the debrief itself reflected how we had functioned during the code. People listened to one another. They asked questions. They challenged assumptions without attacking individuals. They stayed focused on the patient and on the shared goal of improving care. The conversation was not accusatory or emotionally charged. It was thoughtful, candid, and constructive.
There is something revealing about a team that can hold two truths at once: We did something difficult well, and we can still improve. Success can tempt us to move on too quickly. A poor outcome can tempt us to search for someone to blame. Neither response helps a team grow. This group did something different. They examined the event honestly without losing sight of what had gone well…and without losing sight of the people who had carried it out.
As the code captain, I guided both the resuscitation and the discussion. But, I was not responsible for every task, decision, or observation in either setting. The team’s performance depended on professional collaboration and trust. The same trust that allowed someone to speak up during the code allowed someone to question a decision afterward. The same respect that helped nurses, physicians, respiratory therapists, pharmacists, and others work together during the resuscitation allowed us to examine our performance without blame when it was over.
The Work After the Work
We spend countless hours preparing teams for the moment when a patient deteriorates. We simulate codes. We practice algorithms. We assign roles. We rehearse what to do when something goes wrong.
Perhaps we should be just as intentional about what happens afterward.
The debriefing that day taught me that what happens after a code is not separate from what happens during it. Both are shaped by the same culture: whether people trust one another, whether they feel safe enough to speak, and whether they believe that questions will be met with curiosity rather than blame.
The code tested our clinical skills. The debrief tested our culture. We need to train for both.
How does your team create space to reflect after a critical event?
1. Dezfulian C, Cabañas JG, Buckley JR, Cash RE, Crowe RP, Drennan IR, Mahgoub M, Mannarino CN, May T, Salcido DD, Uzendu AI, Vogelsong MA, Worth JA, Girotra S. Part 4: Systems of Care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025 Oct 21;152(16_suppl_2):S353-S384. doi: 10.1161/CIR.0000000000001378. Epub 2025 Oct 22. PMID: 41122886; PMCID: PMC13003348.
2. Imperio M, Ireland K, Xu Y, Esteitie R, Tan LD, Alismail A. Clinical team debriefing post-critical events: perceptions, benefits, and barriers among learners. Front Med (Lausanne). 2024 Nov 20;11:1406988. doi: 10.3389/fmed.2024.1406988. PMID: 39635593; PMCID: PMC11614593.
3. Bleijenberg E, Koster RW, de Vries H, Beesems SG. The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation. Resuscitation. 2017;110:1–5. doi: 10.1016/j.resuscitation.2016.08.034
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