Tablet App Aids Adherence to AHA Guidelines for Pediatric Cardiac Arrest

Deviations from AHA resuscitation guidelines for pediatric patients with cardiac arrest can be decreased with an interactive tablet application.

An interactive tablet application is associated with fewer deviations from American Heart Association (AHA) resuscitation guidelines for pediatric cardiac arrest compared with use of the AHA pocket reference card or no cognitive aid, according to a study in JAMA Network Open.

The randomized clinical trial ( Identifier: NCT04619498) evaluated the effectiveness of the PediAppRREST app, an interactive, multimodal, electronic cognitive aid in a tablet app form, for reducing deviations from AHA resuscitation guidelines during the management of simulated pediatric cardiac arrest.

The simulation-based, 3-group parallel trial was conducted between September 2020 and December 2021 at 4 Italian university hospitals, and the analysis occurred from January to June 2022. Participants in pediatrics, emergency medicine, and anesthesiology were randomized to the PediAppRREST app (PediAppRREST intervention group); a paper-based cognitive aid, the AHA Pediatric Advanced Life Support (PALS) pocket reference card (PALS control group); or no cognitive aid (null control group).

The main outcome was the number of deviations from PALS guidelines during management of pediatric cardiac arrest, as measured by a 15-item checklist and error score.

…use of the cognitive aid tablet application improved adherence to resuscitation guidelines, thus demonstrating promise for improving patient outcomes…

The intention-to-treat analysis included 100 teams (300 residents): 32 teams in the PediAppRREST group, 35 in the PALS group, and 33 in the null control group. The participants and team leaders had a mean age of 29.0 (SD 2.2) years, and 65% were women. Among the participants, 210 were residents in pediatrics, 48 were in anesthesiology, and 42 were in emergency medicine.

The PediAppRREST group had a significantly lower mean number of deviations from guideline recommendations based on error scores (mean [SD] 3.4 [2.0] points) vs the 2 control groups (PALS: mean difference, -3.0 [95% CI, -4.0 to -1.94; P <.001]; null control: mean difference, -2.6 [95% CI, -3.6 to -1.5; P <.001]). No statistically significant difference in error scores occurred between the control groups (mean difference, 0.4; 95% CI, -0.6 to 1.5; P =.59).

In analyses stratified by residency programs, the mean number of deviations from the guidelines was decreased in the PediAppRREST group compared with the control groups in each residency group. The per-protocol analysis had comparable findings to the intention-to-treat analysis.

Team clinical performance according to the Clinical Performance Tool score was significantly increased in the PediAppRREST group (mean [SD], 8.9 [1.6]) vs the PALS group (mean difference, 1.4; 95% CI, 0.4-2.3; P =.002) and null control group (mean difference, 1.1; 95% CI, 0.2-2.1; P =.01).

The main limitation of the study was the inclusion of only residents as participants. In addition, the error score used to assess the primary outcome has not been extensively validated, participants and outcome assessors’ blinding was not possible, and it was a simulation-based rather than real-life study.

“This randomized clinical trial found that the use of the cognitive aid tablet application improved adherence to resuscitation guidelines, thus demonstrating promise for improving patient outcomes, although further studies are necessary to confirm these findings and demonstrate its impact in clinical practice,” wrote the investigators.Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies, and one of the authors reported having a patent for the PediAppRREST application pending. Please see the original reference for a full list of authors’ disclosures


Corazza F, Arpone M, Tardini G, et al. Effectiveness of a novel tablet application in reducing guideline deviations during pediatric cardiac arrest: a randomized clinical trial. JAMA Netw Open. Published online August 3, 2023. doi:10.1001/jamanetworkopen.2023.27272