Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study

Abstract

Background The aim of this study was to investigate the effect of feedback devices on visual attention and the quality of pediatric resuscitation. Methods This was a randomized cross-over simulation study at the Medical University of Vienna. Participants were students and neonatal providers performing four resuscitation scenarios with the support of feedback devices randomized. The primary outcome was the quality of resuscitation. Secondary outcomes were total dwell time (=total duration of visit time) on areas of interest and the workload of participants. Results Forty participants were analyzed. Overall, chest compression (P < 0.001) and ventilation quality were significantly better (P = 0.002) when using a feedback device. Dwell time on the feedback device was 40.1% in the ventilation feedback condition and 48.7% in the chest compression feedback condition. In both conditions, participants significantly reduced attention from the infant’s chest and mask (72.9 vs. 32.6% and 21.9 vs. 12.7%). Participants’ subjective workload increased by 3.5% (P = 0.018) and 8% (P < 0.001) when provided with feedback during a 3-min chest compression and ventilation scenario, respectively. Conclusions The quality of pediatric resuscitation significantly improved when using real-time feedback. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively. Impact Cardiopulmonary resuscitation with feedback devices results in a higher quality of resuscitation and has the potential to lead to a better outcome for patients. Feedback devices consume attention from resuscitation providers. Feedback devices were associated with a shift of visual attention to the feedback devices and an increased workload of participants. Increased workload for providers and benefits for resuscitation quality need to be balanced for the best effect.

Advanced Clinical Neonatal Nursing Students’ Transfer of Performance: From Skills Training With Real-Time Feedback on Ventilation to a Simulated Neonatal Resuscitation Scenario

“…It is the responsibility of both the individual healthcare professional, educational institutions and the NICU leadership that knowledge of and skills in providing safe and effective ventilation are repeatedly trained and tested. The results from this study contrast with studies that found that training with real-time feedback improved ventilation performance ( 10 , 14 ), and in the following we discuss potential causes for this discrepancy.…”

“…In previous studies, results from real-time feedback have either been masked or made visible to the participants during ventilation ( 10 , 14 ). In this study, the participants trained their ventilation skills with visible real-time feedback, followed by a simulation without visible feedback.…”

“…Feedback on expired tidal volume (VT e ) and ventilation pressure helps to identify the need to make adjustments in the mask position or in the positioning of the infant, and may also aid the identification of airway obstruction and changes in lung compliance ( 14 ). A recent randomized crossover simulation study found that real-time feedback improved the quality of pediatric resuscitation performed by medical students, neonatal fellows and consultants, and one nurse ( 10 ), reinforcing that studies on bag-mask ventilation skills training focus largely on medical students and physicians.…”

“…Although, airway management is often the responsibility of physicians and respiratory therapists, the advanced clinical neonatal nurse is expected and required to have the knowledge, technical and non-technical skills, and execute physical and mental tasks, actions, and functions as a part of the resuscitation team. However, studies have shown that even experienced healthcare professionals have problems performing correct bag-mask ventilation ( 9 , 10 ). Challenges include mask leakage, too low or high ventilation rate, and variable delivery of volume and pressure to the lungs ( 9 ).…”

Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis

“…These studies should assess long-term neurodevelopmental outcomes. Studies are also required to determine whether an RFM adds to the attentional and cognitive demands on healthcare providers or diverts attention away from the infant 40–44. It is unclear whether specialised training is required to maximise the benefit of an RFM 43…”