315 - Development and pilot testing of a linear cognitive app to support EMS teams in neonatal and pediatric cardiac arrest resuscitations

Publication Number: 1299.315

Abril Corona-Figueroa, Beth Israel Deaconess Medical Center, Boston, MA, United States; Jeanne-Marie Guise, Beth Israel Deaconess Medical Center, Boston, MA, United States

Background: Pediatric cardiac arrest is a leading cause of child mortality. Most events occur out-of-hospital, where Emergency Medical Services (EMS) provide critical care. Because neonatal and pediatric cardiac arrests are relatively rare, EMS providers have limited exposure and may face higher cognitive demands. Prior studies found that non-linear cognitive aids were associated with delays in cardiac arrest care.

Objective: To develop and test the feasibility of a linear cognitive app (RESCUER) intended to support EMS personnel in responding to neonatal and pediatric out-of-hospital cardiac arrest (POHCA).

Design/Methods: Development and pilot testing of a linear cognitive app that combines NRP and PALS step-by-step algorithmic guidance with age and weight-based pediatric dosing of medications and sizing of equipment. Its linear design provides sequential real-time instructions during resuscitations. We also developed voice-guidance that functions much like AED voice prompts, to allow all team members to stay on track. We conducted preliminary feasibility testing with EMS teams in preparation for a larger planned RCT.

Results: Preliminary tests with rural and urban EMS teams found that users were able to easily understand how to use the app with very little orientation ( < 5 minutes). Users were also able to use the app in simulated cardiac arrest settings without major disruption. However, in one instance, the person holding the app got so enthralled with the simulation that they forgot to start the app for quite a while. By the time they started it, given its linear nature, the instructions were behind the team. While one test among a team consisting of highly experienced EMS trainers found the linear nature frustrating stating that they were thinking many steps ahead, a rural team consisting of newly minted EMTs reported that the app was highly valuable. We also identified one save where a team proceeded with the wrong treatments until the app gave instructions for the correct steps. Voice commands also received mixed results with experienced teams finding it distracting and less experienced rural teams finding it calming in the setting of events which they find highly stressful.

Conclusion(s): Findings from our pilot suggest that using an app to guide clinical care for POHCA, is likely feasible in a variety of settings. It also provided interesting hypotheses regarding the role of experience with linear design and voice prompts. We have started a randomized control trial to evaluate the app in rural and urban EMS practices (NCT06768099 clinical trials.gov).