Provider visual attention on a respiratory function monitor during neonatal resuscitation

Herrick, Heidi; Weinberg, Danielle; Cecarelli, Charlotte; Fishman, Claire E; Newman, Haley; den Boer, Maria C; Martherus, Tessa; Katz, Trixie A; Nadkarni, Vinay; te Pas, Arjan B; Foglia, Elizabeth E

doi:10.1136/archdischild-2020-319291

Cited by 15 publications

(12 citation statements)

References 8 publications

(8 reference statements)

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“…2) and away from the manikin consistent with former studies. 31,32 However, this shift in attention was not harmful to performance in our study. We further observed that more experienced participants spent more time looking at the feedback device than on the manikin.…”

Section: Discussioncontrasting

confidence: 54%

Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study

et al. 2021

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Background The aim of this study was to investigate the effect of feedback devices on visual attention and the quality of pediatric resuscitation. Methods This was a randomized cross-over simulation study at the Medical University of Vienna. Participants were students and neonatal providers performing four resuscitation scenarios with the support of feedback devices randomized. The primary outcome was the quality of resuscitation. Secondary outcomes were total dwell time (=total duration of visit time) on areas of interest and the workload of participants. Results Forty participants were analyzed. Overall, chest compression (P < 0.001) and ventilation quality were significantly better (P = 0.002) when using a feedback device. Dwell time on the feedback device was 40.1% in the ventilation feedback condition and 48.7% in the chest compression feedback condition. In both conditions, participants significantly reduced attention from the infant’s chest and mask (72.9 vs. 32.6% and 21.9 vs. 12.7%). Participants’ subjective workload increased by 3.5% (P = 0.018) and 8% (P < 0.001) when provided with feedback during a 3-min chest compression and ventilation scenario, respectively. Conclusions The quality of pediatric resuscitation significantly improved when using real-time feedback. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively. Impact Cardiopulmonary resuscitation with feedback devices results in a higher quality of resuscitation and has the potential to lead to a better outcome for patients. Feedback devices consume attention from resuscitation providers. Feedback devices were associated with a shift of visual attention to the feedback devices and an increased workload of participants. Increased workload for providers and benefits for resuscitation quality need to be balanced for the best effect.

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Section: Discussioncontrasting

confidence: 54%

Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study

et al. 2021

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“…In a sub-study of this trial, caregivers at two participating centres wore an eye-tracking equipment during the resuscitation, which demonstrated that caregivers did frequently look at the RFM. 18 Unfortunately, this study does not inform us on which RFM variables caregivers focused. It is possible that caregivers saw the RFM data, but familiar parameters, such as chest rise, SpO 2 and HR, were given greater consideration in decisions regarding PPV.…”

Section: Discussionmentioning

confidence: 92%

A multi-centre randomised controlled trial of respiratory function monitoring during stabilisation of very preterm infants at birth

et al. 2021

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Aim: To determine whether the use of a respiratory function monitor (RFM) during PPV of extremely preterm infants at birth, compared with no RFM, leads to an increase in percentage of inflations with an expiratory tidal volume (Vte) within a predefined target range. Methods: Unmasked, randomised clinical trial conducted October 2013 -May 2019 in 7 neonatal intensive care units in 6 countries. Very preterm infants (24-27 weeks of gestation) receiving PPV at birth were randomised to have a RFM screen visible or not. The primary outcome was the median proportion of inflations during manual PPV (face mask or intubated) within the target range (Vte 4-8 mL/kg). There were 42 other prespecified monitor measurements and clinical outcomes. Results: Among 288 infants randomised (median (IQR) gestational age 26 +2 (25 +3 -27 +1 ) weeks), a total number of 51,352 inflations were analysed. The median (IQR) percentage of inflations within the target range in the RFM visible group was 30.0 (18.0-42.2)% vs 30.2 (14.8-43.1)% in the RFM non-visible group (p = 0.721). There were no dierences in other respiratory function measurements, oxygen saturation, heart rate or FiO 2 . There were no dierences in clinical outcomes, except for the incidence of intraventricular haemorrhage (all grades) and/or cystic periventricular leukomalacia (visible RFM: 26.7% vs non-visible RFM: 39.0%; RR 0.71 (0.68-0.97); p = 0.028). Conclusion:In very preterm infants receiving PPV at birth, the use of a RFM, compared to no RFM as guidance for tidal volume delivery, did not increase the percentage of inflations in a predefined target range. Trial registration: Dutch Trial Register NTR4104, clinicaltrials.gov NCT03256578.

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“…These studies should assess long-term neurodevelopmental outcomes. Studies are also required to determine whether an RFM adds to the attentional and cognitive demands on healthcare providers or diverts attention away from the infant 40–44. It is unclear whether specialised training is required to maximise the benefit of an RFM 43…”

Section: Discussionmentioning

confidence: 99%

Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis

Medeiros

Mangat

Polglase

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ImportanceAnimal and observational human studies report that delivery of excessive tidal volume (VT) at birth is associated with lung and brain injury. Using a respiratory function monitor (RFM) to guide VT delivery might reduce injury and improve outcomes.ObjectiveTo determine whether use of an RFM in addition to clinical assessment versus clinical assessment alone during mask ventilation in the delivery room reduces in-hospital mortality and morbidity of infants <37 weeks’ gestation.Study selectionRandomised controlled trials (RCTs) comparing RFM in addition to clinical assessment versus clinical assessment alone during mask ventilation in the delivery room of infants born <37 weeks’ gestation.Data analysisRisk of bias was assessed using Covidence Collaboration tool and pooled into a meta-analysis using a random-effects model. The primary outcome was death prior to discharge.Main outcomeDeath before hospital discharge.ResultsThree RCTs enrolling 443 infants were combined in a meta-analysis. The pooled analysis showed no difference in rates of death before discharge with an RFM versus no RFM, relative risk (RR) 95% (CI) 0.98 (0.64 to 1.48). The pooled analysis suggested a significant reduction for brain injury (a combination of intraventricular haemorrhage and periventricular leucomalacia) (RR 0.65 (0.48 to 0.89), p=0.006) and for intraventricular haemorrhage (RR 0.69 (0.50 to 0.96), p=0.03) in infants receiving positive pressure ventilation with an RFM versus no RFM.ConclusionIn infants <37 weeks, an RFM in addition to clinical assessment compared with clinical assessment during mask ventilation resulted in similar in-hospital mortality, significant reduction for any brain injury and intraventricular haemorrhage. Further trials are required to determine whether RFMs should be routinely available for neonatal resuscitation.

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Provider visual attention on a respiratory function monitor during neonatal resuscitation

Abstract: BackgroundA respiratory function monitor (RFM) provides real-time positive pressure ventilation feedback. Whether providers use RFM during neonatal resuscitation is unknown.MethodsAncillary study to the MONITOR(NCT03256578) randomised controlled trial. Neonatal re… Show more

Cited by 15 publications

References 8 publications

Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study

Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study

A multi-centre randomised controlled trial of respiratory function monitoring during stabilisation of very preterm infants at birth

Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis

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