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

This randomized cross-over simulation study at Medical University of Vienna, was aimed at investigating the effect of feedback devices on visual attention and the quality of pediatric resuscitation.

In total 40 participants were included and each performed 4 resuscitation scenarios with the support of feedback devices randomized. For chest compressions (CC) the QCPR Baby manikin from Laerdal Medical was used, for ventilation scenarios the SimNewB manikin from Laerdal Medical and Neo Training from Monivent was used. 

Primary outcome was quality of chest compressions (CC) and ventilations. Secondary outcomes were participants dwell time, i.e. amount of time spent on a specific area of interest, and subjective workload. Participants showed significant improvements in several CC parameters when provided with real-time feedback. This was also true for the ventilation quality, where participants showed improvements in VTi, VTe and mask leak when provided with real-time feedback, e.g. the mean VTi improved with feedback, increasing from 18% without feedback to 33% with feedback. The proportion of Vte in the 4-8 mL/kg compliance range increased from 36% in the no-feedback condition to 67% in the feedback condition. In addition the mask leakage was 7.5% lower with feedback. 

The majority of participants found the use of both feedback devices (SimPad and Monivent) helpful for visualization of the CC and ventilation quality. The majority of participants (62%) rated the feedback as rather easy to interpret and 36% rather difficult. The authors noted that since 65% of the participants did not have any previous experience with feedback devices which might in part explain their perceived workload. This increase in subjective workload was small and more importantly did not interfere with resuscitation quality.

Conclusion

The authors conclude that resuscitation quality significantly improved when using feedback devices in a simulated setting. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively.