Nabecker Sabine, Nation Kevin, Gilfoyle Elaine, Abelairas-Gomez Cristian, Koota Elina, Lin Yiqun, Greif Robert
Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada.
New Zealand Resuscitation Council, Wellington, New Zealand.
Resusc Plus. 2024 Jun 1;19:100675. doi: 10.1016/j.resplu.2024.100675. eCollection 2024 Sep.
To compare the effectiveness of cognitive aid use during resuscitation with no use of cognitive aids on cardiopulmonary resuscitation quality and performance.
This systematic review followed the PICOST format. All randomised controlled trials and non-randomised studies evaluating cognitive aid use during (simulated) resuscitation were included in any setting. Unpublished studies were excluded. We did not include studies that reported cognitive aid use during training for resuscitation alone. Medline, Embase and Cochrane databases were searched from inception until July 2019 (updated August 2022, November 2023, and 23 April 2024). We did not search trial registries. Title and abstract screening, full-text screening, data extraction, risk of bias assessment (using RoB2 and ROBINS-I), and certainty of evidence (using GRADE) were performed by two researchers. PRISMA reporting standards were followed, and registration (PROSPERO CRD42020159162, version 19 July 2022) was performed. No funding has been obtained.
The literature search identified 5029 citations. After removing 512 duplicates, reviewing the titles and abstracts of the remaining articles yielded 103 articles for full-text review. Hand-searching identified 3 more studies for full-text review. Of these, 29 studies were included in the final analysis. No clinical studies involving patients were identified. The review was limited to indirect evidence from simulation studies only. The results are presented in five different populations: healthcare professionals managing simulated resuscitations in neonates, children, adult advanced life support, and other emergencies; as well as lay providers managing resuscitations. Main outcomes were adherence to protocol or process, adherence to protocol or process assessed by performance score, CPR performance and retention, and feasibility of chatbot guidance. The risk of bias assessment ranged from low to high. Studies in neonatal, paediatric and adult life support delivered by healthcare professionals showed benefits of using cognitive aids, however, some studies evaluating resuscitations by lay providers reported undesirable effects. The performance of a -analysis was not possible due to significant methodological heterogeneity. The certainty of evidence was rated as moderate to very low due to serious indirectness, (very) serious risk of bias, serious inconsistency and (very) serious imprecision.
Because of the very low certainty evidence from simulation studies, we suggest that cognitive aids should be used by healthcare professionals during resuscitation. In contrast, we do not suggest use of cognitive aids for lay providers, based on low certainty evidence.
比较复苏过程中使用认知辅助工具与不使用认知辅助工具对心肺复苏质量和操作的效果。
本系统评价遵循PICOST格式。纳入了在任何环境下评估（模拟）复苏过程中使用认知辅助工具的所有随机对照试验和非随机研究。排除未发表的研究。我们未纳入仅报告在复苏培训期间使用认知辅助工具的研究。检索了Medline、Embase和Cochrane数据库，检索时间从建库至2019年7月（2022年8月、2023年11月和2024年4月23日进行了更新）。我们未检索试验注册库。由两名研究人员进行标题和摘要筛选、全文筛选、数据提取、偏倚风险评估（使用RoB2和ROBINS-I）以及证据确定性评估（使用GRADE）。遵循PRISMA报告标准，并进行了注册（PROSPERO CRD42020159162，2022年7月19日版本）。未获得资金支持。
文献检索共识别出5029条引文。去除512条重复项后，对其余文章的标题和摘要进行审查，得到103篇文章进行全文审查。手工检索又识别出3篇文章进行全文审查。其中，29项研究纳入最终分析。未识别出涉及患者的临床研究。该评价仅限于模拟研究的间接证据。结果在五个不同人群中呈现：管理新生儿、儿童、成人高级生命支持模拟复苏及其他紧急情况的医护人员；以及实施复苏的非专业人员。主要结局包括对方案或流程的依从性、通过绩效评分评估的对方案或流程的依从性、心肺复苏操作及保留情况，以及聊天机器人指导的可行性。偏倚风险评估范围从低到高。医护人员进行的新生儿、儿科和成人生命支持研究表明使用认知辅助工具具有益处，然而，一些评估非专业人员复苏情况的研究报告了不良影响。由于方法学上存在显著异质性，无法进行荟萃分析。由于严重的间接性、（非常）严重的偏倚风险、严重的不一致性以及（非常）严重的不精确性，证据确定性被评为中等至非常低。
由于模拟研究的证据确定性非常低，我们建议医护人员在复苏过程中使用认知辅助工具。相比之下，基于低确定性证据，我们不建议非专业人员使用认知辅助工具。
