Pediatric emergency physician Division of Pediatric Emergency Medicine, University Hospital of Padova, Italy University of Padova Padova, Italy
Background: Cognitive aids are paper-based or digital resources designed to assist healthcare providers in improving adherence to guidelines for the management of cardiac arrest, however their actual effectiveness remains uncertain.
Objective: We aimed to assess the effectiveness of cognitive aids in improving the management of simulated in-hospital cardiac arrest (IHCA) scenarios.
Design/Methods: PubMed, EMBASE, the Cochrane Library, CINAHL and ClinicalTrials.gov were systematically searched to identify studies comparing the management of IHCA simulated scenarios by health professionals using different cognitive aids or no cognitive aids. Our primary outcomes were adherence to guideline recommendations and time to critical resuscitation actions. We performed fixed and random-effects model meta-analysis as appropriate, with assessment of heterogeneity across studies.
Results: Of the 4224 screened studies, 14 met our inclusion criteria (7 evaluating digital aids vs no aids, 3 paper-based aids vs no aids and 4 digital aids vs paper-based aids). Important heterogeneity in the design and outcomes used precluded a meta-analysis of the 12 adult studies. Nonetheless, the use of cognitive aids was associated with a statistically significant improvement in adherence to at least one recommended resuscitation task and in times to critical resuscitation actions in 9/10 and 1/2 studies evaluating these outcomes, respectively. The 2 pediatric studies, from the same research team, compared the use of an app-type cognitive aid with the guideline recommended paper-based resuscitation algorithms. The former tool was associated with improvements in adherence to the guideline recommended sequence of actions, errors in defibrillation and time to first defibrillation, which resulted statistically significant using the fixed effect model meta-analysis (Risk ratio [RR]: 2.57, 95% confidence interval [CI]: 1.32 to 5.02, I2 50%; RR: 0.18, 95% CI: 0.08 to 0.39, I2 0%; and Standard mean difference [SMD]: -0.72, 95% CI: -1.34 to -0.10, I2 81%, respectively). A shorter time to amiodarone administration was also statistically significant according to the random effect model (SMD: -0.78, 95% CI: -1.39 to -0.18, I2 0%). Conclusion(s): Although published studies are limited and heterogenous, the use of cognitive aids appears promising in reducing deviations from guideline recommendations in the management of simulated IHCA scenarios, with potential positive impact on clinical practice.
Authors/Institutions: Francesco Corazza, University of Padova, Padova, , Italy; Elena Fiorese, University of Padova, Padova, , Italy; Marta Arpone, University of Padova, Padova, , Italy; Giacomo Tardini, University of Padova, Padova, , Italy; Adam Cheng, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada; Anna Chiara Frigo, University of Padova, Padova, , Italy; Liviana Da Dalt, University of Padova, Padova, , Italy; Silvia Bressan, University of Padova, Padova, , Italy
