Managing the Unique Size-related Issues of Pediatric Resuscitation: Reducing Cognitive Load with Resuscitation Aids

Abstract

A resuscitation is a complicated event that requires for its optimal outcome the effective completion of a distinct series of actions, some simple, some complex, most occurring simultaneously or in close proximity. In children, these actions are determined not only by the clinical situation, but also by a series of age and size factors particular to each child. Different tasks require different levels of cognitive load, or mental effort. Cognitive load describes the mental burden experienced by the decision maker and will be higher when the task is less familiar or more demanding. In the setting of resuscitation, it refers to the cumulative demands of patient assessment, the ongoing decisions for each of the various steps, and decisions around procedural intervention (e.g., intubation). In children, the level of task complexity and, hence, cognitive load is increased by the unique component of variability of pediatric age and size, introducing logistical factors, many of which involve computations. The purpose of this paper is to examine the effects of age/size-related variables on the pediatric resuscitative process and to explore how these effects can be mitigated using resuscitation aids. The concept of cognitive load and its relation to performance in resuscitation is introduced and is used to demonstrate the effect of the various aids in the pediatric resuscitative process.

Resuscitation Team Organization for Emergency Departments: A Conceptual Review and Discussion

“…2) describing team member positions around the bed. Job aids may organize task priorities, standardize activities, prevent inadvertent oversights, allow faster and more thorough completion of tasks and reduce cognitive load [79][80][81]. They prevent leadership distractions or task drift, ensure a consistent structure to the resuscitation process and decrease team stress.…”

“…They prevent leadership distractions or task drift, ensure a consistent structure to the resuscitation process and decrease team stress. Job aids transfer resuscitation processes from deliberate cognitive processes to automatic reflexes [79,82,83].…”

“…This tape allows the application of preset drug calculations and equipment sizes using an estimate of the child's weight based on the child's length. This system quickly and accurately estimates a child's weight, calculates drug doses and guides equipment size selection [79,86].…”

Patient Safety in the Pediatric Emergency Care Setting

“…Medication dosing, choice of equipment size, and determination of fluid volume for resuscitation all depend on the size of the child; thus, each must be determined or calculated in a high-risk environment by using high-level cognitive skills. Studies have shown that simple tools, such as a length-based tape that provides precalculated medication doses in colorcoded zones, 51 can reduce deviation from the recommended dose range (dosing error) by 25% in simulated resuscitation scenarios, compared with other traditional dosing references. 22 By providing a precalculated dose for a specific length or weight zone, the tool helps to simplify and standardize the complex task of pediatric resuscitation.…”

Profiles in Patient Safety: Medication Errors in the Emergency Department

“…The weight of a child is critically important in pediatric dosing, and strategies have been developed to reduce cognitive errors associated with weighing. 22 Where direct weighing is necessary, it is clearly important to adopt one unit of weight only in the ED to remove any ambiguity.…”