Identifying high cognitive load activities during simulated pediatric cardiac arrest using functional near-infrared spectroscopy

Jonathan Ivankovic; Nathan Bahr; Garth D Meckler; Matthew Hansen; Carl Eriksson; Jeanne-Marie Guise

doi:10.1016/j.resplu.2023.100409

Identifying high cognitive load activities during simulated pediatric cardiac arrest using functional near-infrared spectroscopy

Resusc Plus. 2023 Jun 8:14:100409. doi: 10.1016/j.resplu.2023.100409. eCollection 2023 Jun.

Authors

Jonathan Ivankovic¹, Nathan Bahr¹, Garth D Meckler², Matthew Hansen³, Carl Eriksson⁴, Jeanne-Marie Guise⁵

Affiliations

¹ Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-466, Portland, OR 97239, USA.
² Departments of Pediatrics and Emergency Medicine, University of British Columbia, 24-1160 Nicola Street, Vancouver, BC V6G 2E5, Canada.
³ Department of Emergency Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, HRC 11D01, Portland, OR 97239, USA.
⁴ Department of Pediatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, CDRC 1231, Portland, OR 97239, USA.
⁵ Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, East campus- Kirstein 3rd floor- OBGYN, 330 Brookline Ave, Boston, MA 02215, USA.

Abstract

Aim: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Cognitive load; Functional near-infrared spectroscopy; Out-of-hospital cardiac arrest; Pediatrics; Prehospital emergency care; Simulation.