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Randomized Controlled Trial
. 2023 Aug 1;6(8):e2327272.
doi: 10.1001/jamanetworkopen.2023.27272.

Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest: A Randomized Clinical Trial

Francesco Corazza  1 , Marta Arpone  2 , Giacomo Tardini  2 , Valentina Stritoni  3 , Giulia Mormando  4 , Alessandro Graziano  5 , Paolo Navalesi  5 , Elena Fiorese  2 , Sofia Portalone  2 , Marco De Luca  6 , Marco Binotti  7 , Luca Tortorolo  8 , Serena Salvadei  9 , Alessia Nucci  9 , Alice Monzani  10 , Giulia Genoni  7 , Marco Bazo  2 , Adam Cheng  11   12 , Anna Chiara Frigo  13 , Liviana Da Dalt  2 , Silvia Bressan  2
Affiliations
Randomized Controlled Trial

Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest: A Randomized Clinical Trial

Francesco Corazza et al. JAMA Netw Open. .

Abstract

Importance: Deviations from international resuscitation guidelines during the management of pediatric cardiac arrest are frequent and affect clinical outcomes. An interactive tablet application (app), PediAppRREST, was developed to reduce guideline deviations during pediatric cardiac arrest.

Objective: To assess the effectiveness of PediAppRREST in improving the management of simulated in-hospital pediatric cardiac arrest.

Design, setting, and participants: This multicenter 3-group simulation-based randomized clinical trial was conducted from September 2020 to December 2021 at 4 Italian university hospitals (Padua, Florence, Rome, Novara). Participants included residents in pediatrics, emergency medicine, and anesthesiology. Analyses were conducted as intention-to-treat. Data were analyzed from January to June 2022.

Interventions: Teams were randomized to 1 of 3 study groups: an intervention group that used the PediAppRREST app; a control group that used a paper-based cognitive aid, the Pediatric Advanced Life Support (PALS) pocket card; and a control group that used no cognitive aids. All the teams managed the same standardized simulated scenario of nonshockable pediatric cardiac arrest.

Main outcomes and measures: The primary outcome was the number of deviations from guidelines, measured by a 15-item checklist based on guideline recommendations. The main secondary outcomes were quality of chest compressions, team clinical performance (measured by the Clinical Performance Tool), and perceived team leader's workload. Study outcomes were assessed via video reviews of the scenarios.

Results: Overall 100 teams of 300 participants (mean [SD] age, 29.0 [2.2] years; 195 [65%] female) were analyzed by intention-to-treat, including 32 teams randomized to the PediAppRREST group, 35 teams randomized to the PALS control group, and 33 teams randomized to the null control group. Participant characteristics (210 pediatric residents [70%]; 48 anesthesiology residents [16%]; 42 emergency medicine residents [14%]) were not statistically different among the study groups. The number of deviations from guidelines was significantly lower in the PediAppRREST group than in the control groups (mean difference vs PALS control, -3.0; 95% CI, -4.0 to -1.9; P < .001; mean difference vs null control, -2.6; 95% CI, -3.6 to -1.5; P < .001). Clinical Performance Tool scores were significantly higher in the PediAppRREST group than control groups (mean difference vs PALS control, 1.4; 95% CI, 0.4 to 2.3; P = .002; mean difference vs null control, 1.1; 95% CI, 0.2 to 2.1; P = .01). The other secondary outcomes did not significantly differ among the study groups.

Conclusions and relevance: In this randomized clinical trial, the use of the PediAppRREST app resulted in fewer deviations from guidelines and a better team clinical performance during the management of pediatric cardiac arrest.

Trial registration: ClinicalTrials.gov Identifier: NCT04619498.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Navalesi reported receiving grants from Gilead and Draeger; research equipment from Mindray, Fisher&Paykel, and Draeger; and personal fees from Intersurgical, GSK, Getinge, Mindray, and Gilead outside the submitted work. Dr Bressan reported a having a patent for the PediAppRREST application pending. No other disclosures were reported.

Figures

Figure.
Figure.. Study Recruitment Flowchart
aTwo teams (6 residents) from the PediAppRREST group decided not to use the application.
See this image and copyright information in PMC

References

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