Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest
Abstract Background This methodological intersection article demonstrates a method to measure cognitive load in clinical simulations. Researchers have hypothesized that high levels of cognitive load reduce performance and increase errors. This phenomenon has been studied primarily by experimental de...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Advances in Simulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41077-023-00253-4 |
| _version_ | 1797822982636175360 |
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| author | Nathan Bahr Jonathan Ivankovic Garth Meckler Matthew Hansen Carl Eriksson Jeanne-Marie Guise |
| author_facet | Nathan Bahr Jonathan Ivankovic Garth Meckler Matthew Hansen Carl Eriksson Jeanne-Marie Guise |
| author_sort | Nathan Bahr |
| collection | DOAJ |
| description | Abstract Background This methodological intersection article demonstrates a method to measure cognitive load in clinical simulations. Researchers have hypothesized that high levels of cognitive load reduce performance and increase errors. This phenomenon has been studied primarily by experimental designs that measure responses to predetermined stimuli and self-reports that reduce the experience to a summative value. Our goal was to develop a method to identify clinical activities with high cognitive burden using physiologic measures. Methods Teams of emergency medical responders were recruited from local fire departments to participate in a scenario with a shockable pediatric out-of-hospital cardiac arrest (POHCA) patient. The scenario was standardized with the patient being resuscitated after receiving high-quality CPR and 3 defibrillations. Each team had a person in charge (PIC) who wore a functional near-infrared spectroscopy (fNIRS) device that recorded changes in oxygenated and deoxygenated hemoglobin concentration in their prefrontal cortex (PFC), which was interpreted as cognitive activity. We developed a data processing pipeline to remove nonneural noise (e.g., motion artifacts, heart rate, respiration, and blood pressure) and detect statistically significant changes in cognitive activity. Two researchers independently watched videos and coded clinical tasks corresponding to detected events. Disagreements were resolved through consensus, and results were validated by clinicians. Results We conducted 18 simulations with 122 participants. Participants arrived in teams of 4 to 7 members, including one PIC. We recorded the PIC’s fNIRS signals and identified 173 events associated with increased cognitive activity. [Defibrillation] (N = 34); [medication] dosing (N = 33); and [rhythm checks] (N = 28) coincided most frequently with detected elevations in cognitive activity. [Defibrillations] had affinity with the right PFC, while [medication] dosing and [rhythm checks] had affinity with the left PFC. Conclusions FNIRS is a promising tool for physiologically measuring cognitive load. We describe a novel approach to scan the signal for statistically significant events with no a priori assumptions of when they occur. The events corresponded to key resuscitation tasks and appeared to be specific to the type of task based on activated regions in the PFC. Identifying and understanding the clinical tasks that require high cognitive load can suggest targets for interventions to decrease cognitive load and errors in care. |
| first_indexed | 2024-03-13T10:17:19Z |
| format | Article |
| id | doaj.art-ed89afbae26f40cbacad372b27bf25cb |
| institution | Directory Open Access Journal |
| issn | 2059-0628 |
| language | English |
| last_indexed | 2024-03-13T10:17:19Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Advances in Simulation |
| spelling | doaj.art-ed89afbae26f40cbacad372b27bf25cb2023-05-21T11:11:40ZengBMCAdvances in Simulation2059-06282023-05-01811810.1186/s41077-023-00253-4Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrestNathan Bahr0Jonathan Ivankovic1Garth Meckler2Matthew Hansen3Carl Eriksson4Jeanne-Marie Guise5Department of Obstetrics and Gynecology, Oregon Health and Science UniversityDepartment of Obstetrics and Gynecology, Oregon Health and Science UniversityDepartment of Pediatric Emergency Medicine, University of British ColumbiaDepartment of Emergency Medicine, Oregon Health and Science UniversityDepartment of Pediatrics, Oregon Health and Science UniversityDepartment of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical SchoolAbstract Background This methodological intersection article demonstrates a method to measure cognitive load in clinical simulations. Researchers have hypothesized that high levels of cognitive load reduce performance and increase errors. This phenomenon has been studied primarily by experimental designs that measure responses to predetermined stimuli and self-reports that reduce the experience to a summative value. Our goal was to develop a method to identify clinical activities with high cognitive burden using physiologic measures. Methods Teams of emergency medical responders were recruited from local fire departments to participate in a scenario with a shockable pediatric out-of-hospital cardiac arrest (POHCA) patient. The scenario was standardized with the patient being resuscitated after receiving high-quality CPR and 3 defibrillations. Each team had a person in charge (PIC) who wore a functional near-infrared spectroscopy (fNIRS) device that recorded changes in oxygenated and deoxygenated hemoglobin concentration in their prefrontal cortex (PFC), which was interpreted as cognitive activity. We developed a data processing pipeline to remove nonneural noise (e.g., motion artifacts, heart rate, respiration, and blood pressure) and detect statistically significant changes in cognitive activity. Two researchers independently watched videos and coded clinical tasks corresponding to detected events. Disagreements were resolved through consensus, and results were validated by clinicians. Results We conducted 18 simulations with 122 participants. Participants arrived in teams of 4 to 7 members, including one PIC. We recorded the PIC’s fNIRS signals and identified 173 events associated with increased cognitive activity. [Defibrillation] (N = 34); [medication] dosing (N = 33); and [rhythm checks] (N = 28) coincided most frequently with detected elevations in cognitive activity. [Defibrillations] had affinity with the right PFC, while [medication] dosing and [rhythm checks] had affinity with the left PFC. Conclusions FNIRS is a promising tool for physiologically measuring cognitive load. We describe a novel approach to scan the signal for statistically significant events with no a priori assumptions of when they occur. The events corresponded to key resuscitation tasks and appeared to be specific to the type of task based on activated regions in the PFC. Identifying and understanding the clinical tasks that require high cognitive load can suggest targets for interventions to decrease cognitive load and errors in care.https://doi.org/10.1186/s41077-023-00253-4SimulationPediatric out-of-hospital cardiac arrestEmergency medical servicesCognitive loadFunctional near-infrared spectroscopy |
| spellingShingle | Nathan Bahr Jonathan Ivankovic Garth Meckler Matthew Hansen Carl Eriksson Jeanne-Marie Guise Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest Advances in Simulation Simulation Pediatric out-of-hospital cardiac arrest Emergency medical services Cognitive load Functional near-infrared spectroscopy |
| title | Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest |
| title_full | Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest |
| title_fullStr | Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest |
| title_full_unstemmed | Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest |
| title_short | Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest |
| title_sort | measuring cognitively demanding activities in pediatric out of hospital cardiac arrest |
| topic | Simulation Pediatric out-of-hospital cardiac arrest Emergency medical services Cognitive load Functional near-infrared spectroscopy |
| url | https://doi.org/10.1186/s41077-023-00253-4 |
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