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- Title
Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest.
- Authors
Bahr, Nathan; Ivankovic, Jonathan; Meckler, Garth; Hansen, Matthew; Eriksson, Carl; Guise, Jeanne-Marie
- Abstract
Background: This methodological intersection article demonstrates a method to measure cognitive load in clinical simulations. Researchers have hypothesized that high levels of cognitive load reduce performance and increase errors. This phenomenon has been studied primarily by experimental designs that measure responses to predetermined stimuli and self-reports that reduce the experience to a summative value. Our goal was to develop a method to identify clinical activities with high cognitive burden using physiologic measures. Methods: Teams of emergency medical responders were recruited from local fire departments to participate in a scenario with a shockable pediatric out-of-hospital cardiac arrest (POHCA) patient. The scenario was standardized with the patient being resuscitated after receiving high-quality CPR and 3 defibrillations. Each team had a person in charge (PIC) who wore a functional near-infrared spectroscopy (fNIRS) device that recorded changes in oxygenated and deoxygenated hemoglobin concentration in their prefrontal cortex (PFC), which was interpreted as cognitive activity. We developed a data processing pipeline to remove nonneural noise (e.g., motion artifacts, heart rate, respiration, and blood pressure) and detect statistically significant changes in cognitive activity. Two researchers independently watched videos and coded clinical tasks corresponding to detected events. Disagreements were resolved through consensus, and results were validated by clinicians. Results: We conducted 18 simulations with 122 participants. Participants arrived in teams of 4 to 7 members, including one PIC. We recorded the PIC's fNIRS signals and identified 173 events associated with increased cognitive activity. [Defibrillation] (N = 34); [medication] dosing (N = 33); and [rhythm checks] (N = 28) coincided most frequently with detected elevations in cognitive activity. [Defibrillations] had affinity with the right PFC, while [medication] dosing and [rhythm checks] had affinity with the left PFC. Conclusions: FNIRS is a promising tool for physiologically measuring cognitive load. We describe a novel approach to scan the signal for statistically significant events with no a priori assumptions of when they occur. The events corresponded to key resuscitation tasks and appeared to be specific to the type of task based on activated regions in the PFC. Identifying and understanding the clinical tasks that require high cognitive load can suggest targets for interventions to decrease cognitive load and errors in care.
- Subjects
CARDIOPULMONARY resuscitation; PREFRONTAL cortex; BLOOD pressure; NEAR infrared spectroscopy; SCIENTIFIC observation; CROSS-sectional method; TASK performance; OXYGEN saturation; SIMULATION methods in education; PATIENT monitoring; COMPARATIVE studies; EMERGENCY medical services education; PREVENTIVE health services; CARDIAC arrest; EMERGENCY medical services; HEART beat; DESCRIPTIVE statistics; RESEARCH funding; COGNITIVE testing; EMERGENCY medical personnel; DEFIBRILLATORS; MEDICAL artifacts; RESPIRATION; EMERGENCY medicine; CHILDREN
- Publication
Advances in Simulation, 2023, Vol 8, Issue 1, p1
- ISSN
2059-0628
- Publication type
Article
- DOI
10.1186/s41077-023-00253-4