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Review
. 2024 Jun 1:19:100675.
doi: 10.1016/j.resplu.2024.100675. eCollection 2024 Sep.

Cognitive aids used in simulated resuscitation: A systematic review

Sabine Nabecker  1 , Kevin Nation  2 , Elaine Gilfoyle  3 , Cristian Abelairas-Gomez  4   5 , Elina Koota  6 , Yiqun Lin  7 , Robert Greif  8   9 ; Education Implementation Team Task Force of the International Liaison Committee on Resuscitation (ILCOR)
Collaborators, Affiliations
Review

Cognitive aids used in simulated resuscitation: A systematic review

Sabine Nabecker et al. Resusc Plus. .

Abstract

Objectives: To compare the effectiveness of cognitive aid use during resuscitation with no use of cognitive aids on cardiopulmonary resuscitation quality and performance.

Methods: This systematic review followed the PICOST format. All randomised controlled trials and non-randomised studies evaluating cognitive aid use during (simulated) resuscitation were included in any setting. Unpublished studies were excluded. We did not include studies that reported cognitive aid use during training for resuscitation alone. Medline, Embase and Cochrane databases were searched from inception until July 2019 (updated August 2022, November 2023, and 23 April 2024). We did not search trial registries. Title and abstract screening, full-text screening, data extraction, risk of bias assessment (using RoB2 and ROBINS-I), and certainty of evidence (using GRADE) were performed by two researchers. PRISMA reporting standards were followed, and registration (PROSPERO CRD42020159162, version 19 July 2022) was performed. No funding has been obtained.

Results: The literature search identified 5029 citations. After removing 512 duplicates, reviewing the titles and abstracts of the remaining articles yielded 103 articles for full-text review. Hand-searching identified 3 more studies for full-text review. Of these, 29 studies were included in the final analysis. No clinical studies involving patients were identified. The review was limited to indirect evidence from simulation studies only. The results are presented in five different populations: healthcare professionals managing simulated resuscitations in neonates, children, adult advanced life support, and other emergencies; as well as lay providers managing resuscitations. Main outcomes were adherence to protocol or process, adherence to protocol or process assessed by performance score, CPR performance and retention, and feasibility of chatbot guidance. The risk of bias assessment ranged from low to high. Studies in neonatal, paediatric and adult life support delivered by healthcare professionals showed benefits of using cognitive aids, however, some studies evaluating resuscitations by lay providers reported undesirable effects. The performance of a meta-analysis was not possible due to significant methodological heterogeneity. The certainty of evidence was rated as moderate to very low due to serious indirectness, (very) serious risk of bias, serious inconsistency and (very) serious imprecision.

Conclusion: Because of the very low certainty evidence from simulation studies, we suggest that cognitive aids should be used by healthcare professionals during resuscitation. In contrast, we do not suggest use of cognitive aids for lay providers, based on low certainty evidence.

Keywords: Basic and advanced life support; Cardiopulmonary resuscitation; Checklist; Cognitive aids; Simulation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SN, KN, CAG, EK, and RG are members of the ILCOR EIT Task Force (RG is chair). RG is ERC Director of Guidelines and ILCOR, RG is Editorial Board member of Resuscitation Plus.

Figures

Fig. 1
Fig. 1
Consort flow diagram.
See this image and copyright information in PMC

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