JMIR Publications

ABSTRACT

Background:

Pediatric cardiac arrest (PCA) is a rare and stressful clinical event with high morbidity and mortality. Deviations from recommended management by international guidelines are frequent and are associated with poorer outcomes. Different educational strategies and devices have been developed to improve the management of cardiac arrest, including cognitive support tools in the format of software and applications (App). However, there is very limited experience on the usefulness of interactive cognitive support through an App in PCA. No App has so far been tested for their 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, and Human Machine Interface designers, as well as App developers, from an Italian company, named RE:Lab S.r.l., developed the App between March and October 2019, by applying an iterative design approach (i.e. design, prototyping, and evaluation iterative loops). In October-November 2019, a single-center non-randomized controlled simulation-based pilot study was conducted including 48 pediatric residents, all Pediatric Advanced Life Support providers, divided in teams of three. The same non-shockable 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, while participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX).

Results:

Users’ difficulties in interacting with the tablet App during the simulations were identified and addressed in a re-design phase of the App using a structured framework. The App usability, as measured by the mean UEQ scores, was as follows: attractiveness 1.71 ([standard deviation] 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); novelty 2.21 (SD =0.74). Team leaders’ perceived workload was comparable (P= .57) between the two 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.

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 in this study, the App has been further refined. Its effectiveness in reducing deviations from guideline recommendations in the management of PCA, and impact on time to critical actions, will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.