Oral Themed Presentation
Background: : Optimal cardiopulmonary resuscitation (CPR) can improve pediatric outcomes but rarely is CPR performed perfectly despite numerous iterations of Pediatric Advanced Life Support. Cardiac arrests are complex, often chaotic environments with significant mental and physical workload for team members, especially team leaders. The introduction of a CPR coach, whose sole job is to coordinate high quality CPR, may help improve performance, however, it is unclear how this affects workloads.
Research Question: : How will workload, defined by NASA Task Load Index (NASA-TLX), be affected with the addition of a CPR coach during a simulated CPR scenario?
Methodology: : During a prospective, multicenter, randomized controlled trial evaluating the impact of a CPR Coach on CPR performance during an 18 minute pediatric CPR scenario, we evaluated the work load of all team members using the NASA-TLX. Teams of 5 were randomized to either a CPR Coach or no coach. All teams had a team leader, 2 CPR performers, an airway person and either an additional person or a CPR coach. The CPR coach was trained using rapid cycle deliberate practice just prior to the scenario. Training focused on: perfect CPR utilizing a defibrillator with real-time rate and depth feedback and coordinating CPR actions including pulse checks, switching compressors, defibrillation and intubation. After each scenario, before debriefing, all team members completed a NASA-TLX noting their team role. Outcomes were analyzed using Wilcoxon rank sum test (SAS Version 15.0) due to the non-normal distribution of data. All tests were two-tailed with a significance level of 0.05.
Results: : 41 teams (205 participants) were recruited with one team (5 participants) excluded from analysis due to protocol violation. Demographic data revealed no significant differences between the groups in regards to age, experience, distribution of training (RN, MD, RT). For most workload subscales there were no significant differences between groups. However, CPR providers with a coach (intervention) had a lower mental demand and the team leader in this group had a trend towards lower mental demand scores (p=0.07). Interestingly, the physical demand was significantly higher in the intervention group. When comparing overall excellent CPR, defined as proportion of chest compressions with depth 50-60mm and a rate of 100-120/min, the physical demand domain showed a significant negative correlation between the lower percentages of excellent CPR with higher physical demand scores seen only in the intervention group. Comparing excellent CPR with cognitive load domain scores there was a significant positive correlation in both the intervention and control groups (i.e higher cognitive load scores were associated with a higher percentage of excellent CPR).
Discussion/Conclusions: : The addition of a CPR coach changed some of the task load subscales for CPR teams especially by decreasing mental demand of those performing chest compressions.