Impact of a mobile application for heart rate assessment in simulated neonatal resuscitation: a randomised controlled cross-over study

Abstract

BackgroundClinical assessment of newborn heart rate (HR) at birth has been reported to be inaccurate. NeoTapAdvancedSupport (NeoTapAS) is a free-of-charge mobile application that showed good accuracy in HR estimation. This study aimed to evaluate the impact of NeoTapAS on timing of HR communication and resuscitation interventions.MethodsThis was a randomised controlled cross-over (AB/BA) study evaluating HR assessment using auscultation plus NeoTapAS compared with auscultation plus mental computation in a high-fidelity simulated newborn resuscitation scenario. Twenty teams each including three paediatric residents were randomly assigned to AB or BA arms. The primary outcome was the timing of the first HR communication. Secondary outcomes included the timing of the following four HR communications and the timing of resuscitation interventions (positive pressure ventilation, chest compressions, intubation and administration of first dose of epinephrine).ResultsNeoTapAS reduced the time to the first HR communication (mean difference −13 s, 95% CI −23 to −4; p=0.009), and the time of initiation of chest compressions (mean difference −68 s, 95% CI −116 to −18; p=0.01) and administration of epinephrine (mean difference −76 s, 95% CI −115 to −37; p=0.0004) compared with mental computation.ConclusionsIn a neonatal resuscitation simulated scenario, NeoTapAS reduced the time to the first HR communication and the time of initiation of chest compressions and administration of epinephrine compared with mental computation. This app can be especially useful in settings with limited availability of monitoring equipment, but further studies in clinical scenarios are warranted.Trial registration numberNCT03730025.

Improving newborn heart rate assessment using a simple visual timer

“…Training apps improve performance in both knowledge-based and scenario-based simulations, 12 13 and our findings support this. Furthermore, our study had a comparable categorical error rate as the NeoTapAvancedSupport, 14 an HR estimation app.…”

Evaluation of a Tap-Based Smartphone App for Heart Rate Assessment During Asphyxia in a Porcine Model of Neonatal Resuscitation

“…The NeoTapLifeSupport (NeoTapLS; Tap4Life, Stockholm, Sweden) smartphone app was downloaded from App Store (Apple, Cupertino, CA) and paired with the digital stethoscope for HR assessments. NeoTapLS is a recent development for HR assessment, however has only been tested in high-fidelity resuscitation simulation scenarios (16, 19–21). NeoTapLS displays a HR generated by at least three taps on the smartphone screen, which coincides with what the healthcare provider auscultates.…”

“…More recently, cost-effective and universally accessible assistive technology (e.g., tap-based smartphone and mobile apps) represent another approach to assess HR in newborn infants (16). Simulation studies reported that it is feasible to assess HR using tap-based smartphone applications (19–21). However, this technology has yet to be tested in vivo or during asphyxia in a neonatal model.…”

Smartphone app for neonatal heart rate assessment: an observational study

“… 23 24 In 2019, another simulation study showed that NeoTap reduced the time to the first HR and the time to initiate heart compressions and to administer epinephrine compared with auscultation and mental computation. 25 A porcine model showed that HR assessment with NeoTap had similar accuracy compared with auscultation with a digital stethoscope, ECG or carotid blood flow during asphyxia and faster acquisition time compared with the 6 s or 10 s method with a digital stethoscope. 26 However, data on the clinically important group of HR <60 bpm are few and show contradictory results in the studies above as well as in the present study.…”

“…22 NeoTap has shown promising results from three simulation studies and an animal model. [23][24][25][26] The aim of our study was to evaluate NeoTap by determining the speed and accuracy at which users could assess a rhythm by a metronome (low-end users, midwives well familiar with neonatal resuscitation but with no prior experience of the tapping method), HR in breathing neonates (high-end users, paediatricians well familiar with the tapping method), and HR in neonates in need of positive pressure ventilation (PPV), equal to neonates with insufficient or no breathing at birth (low-end users). The hypothesis was that NeoTap is as fast or faster than PO and ECG and accurate enough to guide neonatal resuscitations.…”