פוסט זה זמין גם ב: עברית
Written by Denrick Cooper
We’re trying something new! Watch quick videos, with my personal take on the articles we cover each week and more! Here’s the JournalFeed YouTube channel link. ~Clay
App-tivating tiny hearts
Pediatric cardiac arrests can induce anal sphincter tightening in EM physicians. (Bless you, PEM folks!). Cognitive aids and checklists can be helpful in reducing medical errors.
In this study, three hundred pediatric, emergency medicine, and anesthesiology residents were randomized in teams to 1 of 3 study arms in a simulation case : 1) intervention group using PediAppRREST app, 2) paper-based PALS cognitive aid, or 3) no cognitive aid. The primary outcome was adherence to a pediatric cardiac arrest 15-item checklist. Secondary outcomes analyzed time of critical interventions, chest compression quality, team clinical performance, usability of app, and team leaders’ workload.
Study results found a lower mean number of deviations in the PediAppRREST group compared to the control groups: mean difference vs PALS control, −3.0 (95%CI −4.0 to −1.9, p < .001); mean difference vs null control, −2.6 (95%CI −3.6 to −1.5, p < .001). The PediAppRREST group had shorter times to perform critical interventions and scored significantly higher on clinical performance tools.
Limitations of the study relate to the methodology. The teams of residents mostly contained pediatric residents and few emergency medicine residents. Additionally, the checklist used in the study focuses on some tasks that are not uniformly necessary in the emergency room setting. Lastly, it is difficult to extrapolate clinical benefit in simulation cases.
How will this change my practice?
Electronic cognitive aids for cardiac arrests can be helpful, and I use them in my current practice. However, it depends on your familiarity with pediatric cardiac arrests and the specific app in question. For those who are less tech savvy or are comfortable with pediatric cardiac arrests, introducing a new technology might only add to the cognitive burden. It is dealer’s choice, but I think worth a try!
Editor’s note: I looked and can’t find this app anywhere. I’d like to see if for myself. Anyone know how to get it? ~Clay Smith
Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest: A Randomized Clinical Trial. JAMA Netw Open. 2023 Aug 1;6(8):e2327272. doi: 10.1001/jamanetworkopen.2023.27272.