Effectiveness of an Interactive Cognitive Support Tablet App to Improve the Management of Pediatric Cardiac Arrest (PediAppRREST)
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
ClinicalTrials.gov Identifier: NCT04619498 |
Recruitment Status :
Completed
First Posted : November 6, 2020
Last Update Posted : May 18, 2022
|
- Study Details
- Tabular View
- No Results Posted
- Disclaimer
- How to Read a Study Record
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Cardiac Arrest | Device: PediAppRREST Other: AHA-PALS pocket reference card | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 324 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Randomized, controlled, three-parallel arm study |
Masking: | None (Open Label) |
Masking Description: | Due to the nature of this study, blinding of the participants, investigators and outcome assessors will not be possible. However, data analyses will be performed by a statistician who will be blinded to the allocation arm (PediAppRREST tablet app, PALS pocket reference card, no cognitive aid). |
Primary Purpose: | Treatment |
Official Title: | PediAppRREST - Effectiveness of an Interactive Cognitive Support Tablet App in Reducing Deviations From Guidelines in the Management of Pediatric Cardiac Arrest: a Simulation-based Randomized Controlled Trial |
Actual Study Start Date : | September 21, 2020 |
Actual Primary Completion Date : | December 31, 2021 |
Actual Study Completion Date : | December 31, 2021 |
Arm | Intervention/treatment |
---|---|
Experimental: PediAppRREST app
The teams assigned to the PediAppRREST arm will manage the simulated scenario of pediatric cardiac arrest using the new PediAppRREST tablet app as a cognitive aid.
|
Device: PediAppRREST
PediAppRREST is a new audiovisual interactive app for tablets developed to support the management of pediatric cardiac arrest. It sequentially displays directions on recommended management interventions. It was specifically designed to guide the team leader to perform resuscitation interventions in the sequence/timing and modality reported by the American Heart Association Pediatric Advanced Life Support (AHA-PALS) guidelines. |
Active Comparator: CtrlPALS+
The teams assigned to the CtrlPALS+ arm will manage the simulated scenario of pediatric cardiac arrest using the American Heart Association Pediatric Advanced Life Support (AHA-PALS) pocket reference card.
|
Other: AHA-PALS pocket reference card
It is a 10 cm x 16.5 cm, full-color, 2-sided, 6-panel card that shows the American Heart Association Pediatric Advanced Life Support (AHA-PALS) treatment algorithms. By providing a quick reference tool, it serves as a cognitive aid for healthcare providers who either direct or participate in the management of pediatric respiratory and/or cardiovascular emergencies, including cardiac arrest. |
No Intervention: CtrlPALS-
The teams assigned to the CtrlPALS- arm will manage the simulated scenario of pediatric cardiac arrest using no PALS-related cognitive aids.
|
- Deviations from American Heart Association Pediatric Advanced Life Support (AHA-PALS) guidelines [ Time Frame: Scenario will be video recorded and evaluated by two independent video reviewers. Outcome assessors will score teams' performance by means of the c-DEV15plus score using data extracted by video reviewers through study completion, an average of 15 months. ]Deviations from AHA-PALS guidelines recommendations are defined as delays and errors according to a novel checklist we derived from a previously published checklist, denominated c-DEV (circulation-deviations), published by Wolfe et al. (2020), by integrating it with evidence-based guidelines, previously reported scoring tools and checklists. We named our new modified checklist c-DEV15plus (circulation-deviations 15 plus). It includes 15 items, which represent correct critical actions for pediatric resuscitation. Each item of the c-DEV15plus is scored either as 0, when the action is performed correctly and timely, as described in the item, or as 1, when the action is not undertaken, undertaken incorrectly, or with wrong timing. The sum of the points attributed to the items represents the c-DEV15plus total score, hence ranging from a minimum of 0 to a maximum of 15, with higher scores corresponding to a higher number of deviations from the guidelines and a worse performance.
- Recognition of cardiac arrest (pulsenessness) [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the pulsessness recognition, through study completion, an average of 15 months. ]The percentage of teams that recognize cardiac arrest (pulselessness).
- Time to cardiac arrest (pulsenessness) recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to pulselessness recognition, through study completion, an average of 15 months. ]Time from the beginning of the scenario to the recognition of cardiac arrest (pulselessness), in seconds.
- Performance of chest compressions [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the performance of chest compressions, through study completion, an average of 15 months. ]Percentage of teams that start chest compressions.
- Time to start chest compressions from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to start chest compressions, through study completion, an average of 15 months. ]Time from the recognition of cardiac arrest to the start of chest compressions, in seconds.
- Time to start chest compressions from the beginning of the scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to start chest compressions, through study completion, an average of 15 months. ]Time from the beginning of the scenario to the start of chest compressions, in seconds.
- Performance of ventilation [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the start of ventilation, through study completion, an average of 15 months. ]Percentage of teams that start ventilation.
- Time to start of ventilation from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to start ventilation, through study completion, an average of 15 months. ]Time from the recognition of cardiac arrest to the start ventilation, in seconds.
- Time to start of ventilation from the beginning of the scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to start ventilation, through study completion, an average of 15 months. ]Time from the beginning of the scenario to the start ventilation, in seconds.
- Use a cardiopulmonary resuscitation board or a rigid surface underneath the manikin [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the use of a cardiopulmonary resuscitation board or a rigid surface underneath the manikin, through study completion, an average of 15 months. ]Percentage of teams that use a cardiopulmonary resuscitation board or a rigid surface underneath the manikin.
- Time to use a cardiopulmonary resuscitation board or a rigid surface underneath the manikin from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to use a cardiopulmonary resuscitation board or a rigid surface underneath the manikin, through study completion, an average of 15 months. ]Time from the recognition of cardiac arrest to the use of a cardiopulmonary resuscitation board or a rigid surface underneath the manikin, in seconds.
- Time to use a cardiopulmonary resuscitation board or a rigid surface underneath the manikin from the beginning of the scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to use a cardiopulmonary resuscitation board or a rigid surface underneath the manikin, through study completion, an average of 15 months. ]Time from the beginning of the scenario to the use of a cardiopulmonary resuscitation board or a rigid surface underneath the manikin, in seconds.
- Call for emergency team help [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the call for emergency team help, through study completion, an average of 15 months. ]Percentage of teams that call for emergency team help.
- Time to call for emergency team help from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to call for emergency team help, through study completion, an average of 15 months. ]Time from the recognition of cardiac arrest to call for emergency team help, in seconds.
- Time to call for emergency team help from the beginning of the scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to call for emergency team help, through study completion, an average of 15 months. ]Time from the beginning of the scenario to call for emergency team help, in seconds.
- Use of electrocardiogram monitoring [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the use of electrocardiogram monitoring, through study completion, an average of 15 months. ]Percentage of teams that use of electrocardiogram monitoring.
- Time to start electrocardiogram monitoring from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to start electrocardiogram monitoring, through study completion, an average of 15 months. ]Time from cardiac arrest recognition to start of electrocardiogram monitoring, in seconds.
- Time to start electrocardiogram monitoring from the beginning of scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to start electrocardiogram monitoring, through study completion, an average of 15 months. ]Time from the beginning of the scenario to start of electrocardiogram monitoring, in seconds.
- Administration of a correct first epinephrine [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the correct administration of the first epinephrine, through study completion, an average of 15 months. ]Percentage of teams that perform a correct first epinephrine administration (correct dose, dilution, route, followed by a normal saline flush).
- Time to first epinephrine administration from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to the first epinephrine administration, through study completion, an average of 15 months. ]Time from the recognition of cardiac arrest to the first epinephrine administration, in seconds.
- Time to first epinephrine administration from the beginning of the scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to the first epinephrine administration, through study completion, an average of 15 months. ]Time from the beginning of the scenario to the first epinephrine administration, in seconds.
- Administration of a correct second epinephrine [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the correct administration of the second epinephrine dose, through study completion, an average of 15 months. ]Percentage of teams that perform a correct second epinephrine administration (correct dose, dilution, route, followed by a normal saline flush).
- Time to second epinephrine administration from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to second epinephrine administration, through study completion, an average of 15 months. ]Time from the recognition of cardiac arrest to the second epinephrine administration, in seconds.
- Time to second epinephrine administration from the beginning of the scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to second epinephrine administration, through study completion, an average of 15 months. ]Time from the beginning of the scenario to the second epinephrine administration, in seconds.
- Treatment of reversible causes [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the correct treatment of reversible causes, through study completion, an average of 15 months. ]Percentage of teams that correctly treat at least one reversible cause (hypovolemia or hypoglycemia).
- Time to treatment of reversible causes from arrest recognition [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to treatment of reversible causes, through study completion, an average of 15 months. ]Time from the recognition of cardiac arrest to the treatment of reversible causes, in seconds.
- Time to treatment of reversible causes from the beginning of the scenario [ Time Frame: Scenario will be video recorded and successively two independent video reviewers will assess the time to treatment of reversible causes, through study completion, an average of 15 months. ]Time from the beginning of the scenario to the treatment of reversible causes, in seconds.
- Usability of the app - System Usability Scale [ Time Frame: Questionnaires will be completed after each simulated scenario through study completion, an average of 15 months. ]To assess the PediAppRREST app usability, the team leaders of the intervention group will complete one validated questionnaire, the System Usability Scale (SUS). It consists of a 10-item questionnaire with five response options. Its scores ranges from a minimum of 0 to a maximum of 100. Higher scores corresponde to a better usability.
- Usability of the app - Open-ended questions [ Time Frame: Questionnaires will be completed after each simulated scenario through study completion, an average of 15 months. ]To further assess the PediAppRREST app usability, the team leaders of the intervention group will answer open-ended questions about app usability in a questionnaire.
- Team leaders' workload [ Time Frame: Questionnaires will be completed by team leaders after each simulated scenario through study completion, an average of 15 months. ]Team leaders' workload measured by the validated, multidimensional NASA-Task Load Index (NASA-TLX) questionnaire. The values of this score range from a minimum of 0 to a maximum of 100. A higher value means a higher perceived workload.
- Cardiopulmonary resuscitation (CPR) quality - Mean chest compression rate [ Time Frame: CPR quality data will be extracted by the manikin's software after each simulated scenario, through study completion, an average of 15 months. ]CPR quality will be measured by the Skill Reporter (Laerdal™), the software associated to the manikin (Resusci Junior, Laerdal™). Mean chest compression rate is expressed in number of compressions/minute.
- Cardiopulmonary resuscitation (CPR) quality metrics - Mean chest compression depth [ Time Frame: CPR quality data will be extracted by the manikin's software after each simulated scenario, through study completion, an average of 15 months. ]CPR quality will be measured by the Skill Reporter (Laerdal™), the software associated to the manikin (Resusci Junior, Laerdal™). The mean chest compression depth is reported in millimeters.
- Cardiopulmonary resuscitation (CPR) quality metrics - Compression depth correctness [ Time Frame: CPR quality data will be extracted by the manikin's software after each simulated scenario, through study completion, an average of 15 months. ]CPR quality will be measured by the Skill Reporter (Laerdal™), the software associated to the manikin (Resusci Junior, Laerdal™). Compression depth correctness is defined as the proportion of chest compressions with a correct depth of 50-60 mm, according to AHA standards.
- Cardiopulmonary resuscitation (CPR) quality metrics - Chest compressions fraction [ Time Frame: CPR quality data will be extracted by the manikin's software after each simulated scenario, through study completion, an average of 15 months. ]CPR quality will be measured by the Skill Reporter (Laerdal™), the software associated to the manikin (Resusci Junior, Laerdal™). The chest compression fraction is defined as the proportion of resuscitation time during which chest compressions are administered.
- Team resuscitation performance [ Time Frame: Scenario will be video recorded and successively evaluated by two independent video reviewers. Outcome assessors will score teams' performance by means of CPT using data extracted by video reviewers, through study completion, an average of 15 months. ]Team resuscitation performance will be evaluated using the Clinical Performance Tool (CPT). The CPT is a validated scoring system designed based on AHA PALS algorithms, through which sequence, timing, and quality of specific actions, during different simulated scenarios, can be assessed. Outcome assessors will use the CPT section for the asystole scenario to evaluate teams' performance. The values of this score range from a minimum of 0 to a maximum of 13. Higher scores correspond to a better team performance.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 24 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- to be attending a medical residency training program in Pediatrics, Anesthesiology-Intensive Care or Emergency Medicine
- to be BLS (Basic Life Support) or P-BLS (Pediatric-Basic Life Support) or PALS (Pediatric Advanced Life Suport) or ALS (Advanced Life Support) or ACLS (Advanced Cardiac Life Support) certified, following the American Heart Association (AHA) or the European Resuscitation Council (ERC) courses
- to give consent to participate to the study and to be video-recorded.
Additionally, to be eligible for the role of team leader, residents must be PALS-certified according to AHA or ERC guidelines
Exclusion Criteria:
- to be unable to attend the simulation sessions because of personal leave, maternity/paternity leave, sick leave or training abroad
- participation in previous studies using the PediAppRREST app
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04619498
Italy | |
Azienda Ospedaliera Universitaria Meyer, University of Firenze | |
Firenze, Italy | |
Azienda Ospedaliera Universitaria Maggiore della Carità, Università del Piemonte Orientale | |
Novara, Italy | |
Azienda Ospedale Università di Padova, University of Padova | |
Padova, Italy | |
Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore | |
Roma, Italy |
Principal Investigator: | Silvia Bressan, MD, PhD | University of Padova | |
Principal Investigator: | Francesco Corazza, MD | University of Padova |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Silvia Bressan, Assistant professor, Attending Physician in Pediatric Emergency Medicine, MD, PhD., University of Padova |
ClinicalTrials.gov Identifier: | NCT04619498 |
Other Study ID Numbers: |
BIRD191291 |
First Posted: | November 6, 2020 Key Record Dates |
Last Update Posted: | May 18, 2022 |
Last Verified: | May 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
cardiac arrest resuscitation cognitive aid mobile app |
emergency medicine simulation pediatrics |
Heart Arrest Heart Diseases Cardiovascular Diseases |