The Use of Cognitive Aids During Simulated Pediatric Cardiopulmonary Arrests.
Nelson, Kristen L. MD; Shilkofski, Nicole A. MD; Haggerty, Jamie A. EMT-B; Saliski, Mary MSN, CPNP; Hunt, Elizabeth A. MD, MPH, PhD
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.
3(3):138-145, Fall 2008.
(Format: HTML, PDF)
Background: Management of pediatric cardiopulmonary arrest (CPA) is challenging because of the low volume of experience of most pediatric health care providers. Use of cognitive aids may assist in making rapid decisions in these crises; however, there are no known published reports on whether these aids are actually used during arrest management and whether they impact quality of care.
Methods: Sixty pediatric residents participated in individual simulated CPA scenarios, which involved pulseless ventricular tachycardia and pulseless electrical activity. Our primary outcome measure was the proportion of pediatric residents who used cognitive aids during simulated CPAs. Secondary outcome measures were to quantify 1) type of aids used, 2) category of use, and 3) human errors made during resuscitation efforts.
Results: Eighty-five percent of residents voluntarily used a cognitive aid to assist in managing simulated pediatric CPAs. The most commonly used aids were an American Heart Association Pediatric Advanced Life Support aid and an institutionally created aid. Forty-three of 51 (84.3%) and 23 of 46 (60.5%) residents used these aids for assistance with the pulseless ventricular tachycardia and pulseless electrical activity algorithm, respectively. Unfortunately, 13 of 51 (25.5%) residents chose the incorrect treatment algorithm, resulting in inappropriate management.
Conclusion and Application: Although the majority of residents chose to use cognitive aids for assistance, errors in management were common. Further study is required to determine whether these errors are associated with cognitive aid design flaws and whether improving their design through human factors research can help minimize errors in Basic and Advanced Life Support, ultimately improving patient outcomes.
(C) 2008 Society for Simulation in Healthcare