Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study

Abstract

Background Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.

PediAppRREST: effectiveness of an interactive cognitive support tablet app in reducing deviations from guidelines in the management of paediatric cardiac arrest: protocol for a simulation-based randomised controlled trial

“…Additionally, to be eligible for the role of team leader residents must be PALS-certified according to AHA or ERC guidelines. Residents who took part in the pilot study of the PediAppRREST app, 37 or who are unable to attend the simulation sessions because of maternity/paternity leave, sick/personal leave or training abroad are not eligible to participate in the trial.…”

“…Deviations from PALS guideline recommendations are defined as delays and errors according to a novel checklist we derived from the previously published checklist by Wolfe et al , 20 denominated c-DEV, by integrating it with evidence-based guidelines, 6–8 11 previously reported scoring tools 40–43 and checklists. 37 44 45 We named our new modified checklist c-DEV15plus. It includes 15 items, which represent correct critical actions for paediatric resuscitation ( box 1 ).…”

“…The PediAppRREST, is an interactive, multimodal (audio-visual), ‘checklist’ app, sequentially displaying prompts on recommended PCA management interventions. 37 It was specifically designed in 2019 to guide the team leader to perform resuscitation interventions in the sequence/timing and modality reported by the AHA PALS 2015 guidelines. 6–8 …”

“…We developed and refined a new audio-visual interactive app for tablets, named PediAppRREST, to support the management of PCA. 37 The app was developed based on the results of a multicentre observational simulation-based study, conducted by our research team, evaluating errors and delays in the management of a PCA scenario by paediatric residents. 38 We also tested the app usability in a pilot simulation-based study of non-shockable PCA scenarios, managed by paediatric residents, all PALS certified providers.…”

“…The app received good usability evaluations and it did not increase the team leader’s perceived workload compared with the control group that did not use any cognitive support tool. 37 No app that has previously been tested for usability and associated perceived workload, has so far been evaluated in a large, appropriately powered, randomised clinical trial, involving physicians from different medical specialties, for its efficacy in guiding the management of PCA.…”