Identifying high cognitive load activities during simulated pediatric cardiac arrest using functional near-infrared
Jonathan Ivankovic1, Nathan Bahr1, Garth D Meckler2
1Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA.
Insights
Emergency medical services (EMS) providers experienced high cognitive load during simulated pediatric resuscitation tasks like medication administration and defibrillation. Understanding these demands can improve interventions and reduce cognitive burden.
Area of Science:
- Emergency Medicine
- Neuroscience
- Human Factors Engineering
Background:
- Pediatric out-of-hospital cardiac arrest (POHCA) resuscitation is a high-stress event requiring complex decision-making.
- Assessing cognitive load in real-time during emergency medical services (EMS) operations is challenging.
- Functional near-infrared spectroscopy (fNIRS) offers a non-invasive method to monitor brain activity.
Purpose of the Study:
- To identify specific activities associated with high cognitive load during simulated POHCA resuscitation.
- To utilize physiological monitoring with fNIRS to quantify cognitive demand in EMS teams.
- To inform interventions aimed at reducing cognitive burden during critical care scenarios.
Main Methods:
- Recruited EMS teams (paramedics and EMTs) for POHCA simulations.
- Utilized OctaMon fNIRS device to measure prefrontal cortex activity in the person in charge (PIC).
- Correlated fNIRS signals (changes in oxygenated/deoxygenated hemoglobin) with concurrent clinical tasks recorded via video review.
Main Results:
- Recorded cognitive activity in 18 POHCA simulations.
- Identified high cognitive load in PICs during medication administration, defibrillation, and rhythm checks.
- Observed increased cognitive activity linked to coordinating team actions for critical interventions.
Conclusions:
- EMS providers face significant cognitive demands during key POHCA resuscitation tasks.
- Medication administration, defibrillation, and rhythm/pulse checks are particularly cognitively taxing.
- Understanding high-demand activities can guide the development of strategies to mitigate cognitive load and improve patient care.
Aim:
To identify specific activities associated with high cognitive load during simulated pediatric out-of-hospital cardiac arrest (POHCA) resuscitation using physiological monitoring with functional near-infrared spectroscopy (fNIRS).
Methods:
We recruited teams of emergency medical services (EMS) responders from fire departments located throughout the Portland, OR metropolitan area to participate in POHCA simulations. Teams consisted of both paramedics and emergency medical technicians (EMTs), with one paramedic serving as the person in charge (PIC). The PIC was outfitted with the OctaMon to collect fNIRS signals from the prefrontal cortex. Signals reported changes in oxygenated and deoxygenated hemoglobin concentrations, which were used to determine moments of increased cognitive activity. Increased cognitive activity was determined by significant increases in oxygenated hemoglobin and decreases in deoxygenated hemoglobin. Significant changes in fNIRS signals were associated with specific concurrent clinical tasks recorded by two independent researchers using video review.
Results:
We recorded cognitive activity of EMS providers in 18 POHCA simulations. We found that a proportion of PIC's experienced relatively high cognitive load during medication administration, defibrillation, and rhythm checks compared to other events.
Conclusion:
EMS providers commonly experienced increased cognitive activity during key resuscitation tasks that were related to safely coordinating team members around calculating and administering medications, defibrillation, and rhythm and pulse checks. Understanding more about activities that require high cognitive demand can inform future interventions that reduce cognitive load.
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