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Forgetting the Basics of CPR: Do Cognitive Aids Really Help?

Do Cognitive Aids Really Help?

If you have been in healthcare for fifteen or more years, you may recall attending an ACLS that ended with one or more learners running out of the classroom crying because they failed to take the correct action at the correct time. Fast forward to todays' BLS, ACLS and PALS classes and new learners might not appreciate the huge difference for the allowance of cognitive aids during testing

Watch how a cognitive aid is used in a simulated OR arrest case

 What is a Cognitive Aid?

A cognitive aid is a collection of tools designed to bring about correct task completion. Many of us might correctly think of a cognitive aid as a check list or reminder list. Some of us might think of the check list pilots use to make sure everything is safe to fly. 

Check Lists, A Sign of Weakness?

At the CPR Training Company we are huge fans of using cognitive aids during cardiac arrest training because we want to train like we fight. But our research shows cognitive aids are not frequently used and often viewed as a sign of weakness.

For example on a Post Code Debriefing Tool we ask staff: "On a scale of 1-7, with 7 meaning used cognitive aids all the time and 1 meaning did not use cognitive aids all the time, how well did the team leader (or their designee) use cognitive aids in the code event?" We found that cognitive aids are used only 5% of the time in adult codes.

A recent Simulation in Healthcare Journal article suggests several interesting points on cognitive aid usage in relation to a simulated PALS case:

  • Participants took 106 seconds (average) to access and use a cognitive aid*
  • Of the 46% who recognized there was no pulse, only 3% corrected their action based upon the information found on the cognitive aid (started CPR), which means the cognitive aids were not effective in starting CPR any quicker or even helping staff recall the correct action in the first place…if anything CPR was delayed by the use of cognitive aids in this study*
Location, Color, Text Size, Content all become major items to consider.
Important Items Moved To The Top (Example for BLS User)

One last point comes to mind. As a critical care nurse, I have spent my entire working life in just about every resuscitation environment (EMS, Flight, Cath Labs, dedicated code teams, clinical simulation centers, etc.). My practical experience suggests the person using the cognitive aid must not be directly responsible for directing the team's actions (i.e. Code Team Leader) or taking any other action. The best option is to have a dedicated team member feed information (from the cognitive aid) to the code team leader. This delineation of tasks frees up memory, thereby allowing the team leader to remain informed upon request or upon missing a critical action item.

Why Use Cognitive Aids?

In the end cognitive aids, in a cardiac arrest event, are a valuable tool so long as their limitations are understood. Cognitive aids do not appear to help someone start CPR quicker. Yet a cognitive aid can help staff recall the correct depth and rate for compressions. Cognitive aids are also useful in bring about better team work, improving technical insights, and memory aids for basic interventions (like placing a backboard under the patient). I hope you will consider developing a resuscitation cognitive aid with this article's ideas in mind. 

*McMillan, K. N., MD, Rosen, M. A., Shilkofski, N. A., Bradshaw, J. H., Saliski, M., & Hunt, E. A. (2018). Cognitive Aids Do Not Prompt Initiation of Cardiopulmonary Resuscitation in Simulated Pediatric Cardiopulmonary Arrests. Simulation in Healthcare,13(1), 41-46.  

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CPR Is A System Effort
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