Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study

Francesco Corazza, Deborah Snijders, Marta Arpone, Valentina Stritoni, Francesco Martinolli, Marco Daverio, Maria Giulia Losi, Luca Soldi, Francesco Tesauri, Liviana Da Dalt, Silvia Bressan, Francesco Corazza, Deborah Snijders, Marta Arpone, Valentina Stritoni, Francesco Martinolli, Marco Daverio, Maria Giulia Losi, Luca Soldi, Francesco Tesauri, Liviana Da Dalt, Silvia Bressan

Abstract

Background: Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its 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 (Italy) and human-machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design-prototyping-evaluation iterative loops). In October-November 2019, a single-center nonrandomized controlled simulation-based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable 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, whereas participants' workload was measured using the NASA Raw-Task Load Index (NASA RTLX).

Results: Users' difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (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), and novelty 2.21 (SD 0.74). Team leaders' perceived workload was comparable (P=.57) between the 2 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. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015).

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 and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.

Keywords: cardiac arrest; cognitive aid; emergency medicine; high-fidelity simulation training; mobile app; pediatrics; resuscitation.

Conflict of interest statement

Conflicts of Interest: The authors affiliated with RE:Lab had no direct involvement in the project, other than the technical activities related to the development of the app. All the other authors have no conflict of interest to declare neither with the RE:Lab company nor with other companies.

©Francesco Corazza, Deborah Snijders, Marta Arpone, Valentina Stritoni, Francesco Martinolli, Marco Daverio, Maria Giulia Losi, Luca Soldi, Francesco Tesauri, Liviana Da Dalt, Silvia Bressan. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 01.10.2020.

Figures

Figure 1
Figure 1
Sequential versus alternative choices. CPR: cardiopulmonary resuscitation; ROSC: return of spontaneous circulation.
Figure 2
Figure 2
User interface main areas. CPR: cardiopulmonary resuscitation; ROSC: return of spontaneous circulation; VF: ventricular fibrillation; VT: ventricular tachycardia.
Figure 3
Figure 3
Cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC) information. EKG: electrocardiogram; EtCO2: end-tidal CO2; FiO2: fraction of inspired oxygen; SaO2: oxygen saturation measured with pulse oximetry.
Figure 4
Figure 4
Epinephrine administration screens. CPR: cardiopulmonary resuscitation; ROSC: return of spontaneous circulation.
Figure 5
Figure 5
Reversible causes and airway management screens. CPR: cardiopulmonary resuscitation; ROSC: return of spontaneous circulation.
Figure 6
Figure 6
Epinephrine preparation and administration screens. CPR: cardiopulmonary resuscitation; ROSC: return of spontaneous circulation.

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