Ivankovic Jonathan, Bahr Nathan, Meckler Garth D, Hansen Matthew, Eriksson Carl, Guise Jeanne-Marie
Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA.
Departments of Pediatrics and Emergency Medicine, University of British Columbia, 24-1160 Nicola Street, Vancouver, BC V6G 2E5, Canada.
Resusc Plus. 2023 Jun 8;14:100409. doi: 10.1016/j.resplu.2023.100409. eCollection 2023 Jun.
To identify specific activities associated with high cognitive load during simulated pediatric out-of-hospital cardiac arrest (POHCA) resuscitation using physiological monitoring with functional near-infrared spectroscopy (fNIRS).
We recruited teams of emergency medical services (EMS) responders from fire departments located throughout the Portland, OR metropolitan area to participate in POHCA simulations. Teams consisted of both paramedics and emergency medical technicians (EMTs), with one paramedic serving as the person in charge (PIC). The PIC was outfitted with the OctaMon to collect fNIRS signals from the prefrontal cortex. Signals reported changes in oxygenated and deoxygenated hemoglobin concentrations, which were used to determine moments of increased cognitive activity. Increased cognitive activity was determined by significant increases in oxygenated hemoglobin and decreases in deoxygenated hemoglobin. Significant changes in fNIRS signals were associated with specific concurrent clinical tasks recorded by two independent researchers using video review.
We recorded cognitive activity of EMS providers in 18 POHCA simulations. We found that a proportion of PIC's experienced relatively high cognitive load during medication administration, defibrillation, and rhythm checks compared to other events.
EMS providers commonly experienced increased cognitive activity during key resuscitation tasks that were related to safely coordinating team members around calculating and administering medications, defibrillation, and rhythm and pulse checks. Understanding more about activities that require high cognitive demand can inform future interventions that reduce cognitive load.
使用功能近红外光谱（fNIRS）进行生理监测，以识别模拟儿科院外心脏骤停（POHCA）复苏期间与高认知负荷相关的特定活动。
我们招募了来自俄勒冈州波特兰市大都市区各地消防部门的紧急医疗服务（EMS）响应团队，参与POHCA模拟。团队由护理人员和急救医疗技术员（EMT）组成，其中一名护理人员担任负责人（PIC）。PIC配备了OctaMon，以从前额叶皮层收集fNIRS信号。信号报告了氧合血红蛋白和脱氧血红蛋白浓度的变化，这些变化用于确定认知活动增加的时刻。认知活动增加是由氧合血红蛋白显著增加和脱氧血红蛋白减少来确定的。fNIRS信号的显著变化与两名独立研究人员通过视频回顾记录的特定同步临床任务相关。
我们在18次POHCA模拟中记录了EMS提供者的认知活动。我们发现，与其他事件相比，一部分PIC在给药、除颤和心律检查期间经历了相对较高的认知负荷。
EMS提供者在关键复苏任务期间通常会经历认知活动增加，这些任务与围绕计算和给药、除颤以及心律和脉搏检查安全协调团队成员有关。更多地了解需要高认知需求的活动可以为未来降低认知负荷的干预措施提供信息。
