Development and usability of PediAppRREST, a novel interactive tablet App to support the management of pediatric cardiac arrest: a pilot high-fidelity simulation-based study (Preprint)

BACKGROUND Pediatric cardiac arrest (PCA) although rare is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an application (App) in PCA. No App has so far been tested for its usability and effectiveness in guiding the management of PCA. OBJECTIVE To develop a new audiovisual interactive App for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. METHODS A research team at the University of Padova (Italy), and human-machine interface designers, as well as App developers, from an Italian company (RE:Lab S.r.l.) developed the App between March and October 2019, by applying an iterative design approach (i.e. design-prototyping-evaluation iterative loops). In October-November 2019, a single-center non-randomized controlled simulation-based pilot study was conducted including 48 pediatric residents divided in teams of three. The same non-shockable PCA scenario was managed by 11 teams with and 5 without the App. The App user's experience and interaction patterns were documented through video recording of scenarios, debriefing sessions and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from -3 to +3 for each scale) and open-ended questions, while participants' workload was measured using the NASA Raw-Task Load Index (NASA RTLX). RESULTS Users' difficulties in interacting with the App during the simulations were identified using a structured framework. The App usability, in terms of UEQ scores, was as follows: attractiveness 1.71 (standard deviation [SD]=1.43); perspicuity 1.75 (SD=0.88); efficiency 1.93 (SD=0.93); dependability 1.57 (SD=1.10); stimulation 1.60 (SD=1.33); novelty 2.21 (SD=0.74). Team leaders' perceived workload was comparable (P=.57) between the two groups, median NASA RTLX score was 67.5 (interquartile range [IQR]=65.0-81.7) for the control group and 66.7 (IQR=54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the App in reducing deviations from guidelines showed that median time to epinephrine was significantly longer in the group that used the App compared to the control group (254 s versus 165 s; P=.015). CONCLUSIONS The PediAppRREST App received a good usability evaluation and did not appear to increase team leaders' workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the App has been further refined. The effectiveness of the new version of the App in reducing deviations from guidelines recommendations in the management of PCA and impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial. CLINICALTRIAL