Development of a Novel Cardiac Arrest Ventilation Rate Metronome: A Human Factors Approach

Tuesday, February 25, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central Theater 1

Amanda O’Halloran, MD, FAAP (she/her/hers)

Children's Hospital of Philadelphia

Disclosure(s): No relevant financial relationship(s) to disclose.
JS

James Sannino, MS

Human Factors Engineer
Children’s Hospital of Philadelphia

Disclosure information not submitted.
Cheryl Dominick, MA

Clinical Respiratory Specialist
Children's Hospital of Philadelphia

Disclosure information not submitted.
CB

Christine Bailey, MSN

Senior Simulation Educator
Children's Hospital of Philadelphia

Disclosure information not submitted.
LB

Lori Boyle, RN

Clinical Nurse Expert
Children's Hospital of Philadelphia

Disclosure information not submitted.
Lindsay N. Shepard, MD (she/her/hers)

Physician-Scientist Interim
Childrens Hospital of Philadelphia

Disclosure information not submitted.
Vinay Nadkarni, MD, MS, FCCM (he/him/his)

Dr.
University of Pennsylvania Perelman School of Medicine, CHOP

Disclosure information not submitted.
HW

Heather Wolfe, MD

Dr.
Children's Hospital of Philadelphia

Disclosure information not submitted.
RM

Ryan Morgan, MD, MTR

Associate Director, Resuscitation Science Center; Associate Professor of Anesthesiology, Critical Ca
Children's Hospital of Philadelphia

Disclosure information not submitted.
Akira Nishisaki, MD, MSCE (he/him/his)

Division of Critical Care Medicine, Department of Anesthesia and Critical Care
The Children's Hospital of Philadelphia

Disclosure information not submitted.
ML

Meghan Lane-Fall, MD MSHP FCCM

Professor of Anesthesiology and Critical Care
University of Pennsylvania School of Medicine

Disclosure information not submitted.
RS

Robert M. Sutton, MD, MSCE, FCCM

Professor of Anesthesiology, Critical Care, and Pediatrics
Children's Hospital of Philadelphia and University of Pennsylvania

Disclosure information not submitted.

Disclosure(s):

Amanda O’Halloran, MD, FAAP: No relevant financial relationship(s) to disclose.

Introduction: Hyperventilation adversely affects CPR hemodynamics and outcomes. Pediatric providers rarely achieve guideline-recommended CPR ventilation rates. Our project aimed to use human factors engineering to design a metronome to improve cardiac arrest ventilation. We hypothesized that in usability testing, our novel metronome would achieve: 1) a System Usability Score (SUS) >70 and 2) >70% of CPR epochs with ventilation rates within target range, which would be considered sufficient to support a pilot trial in our PICU.

Methods: We solicited stakeholder feedback on the proposed ventilation metronome by surveying multidisciplinary PICU clinicians and facilitating participatory design sessions to determine optimal metronome components (audio, visual, etc). During high-fidelity simulation usability testing, we collected qualitative and quantitative measures reflecting participant feedback and performance. Average ventilation rates were calculated during 30-second epochs of CPR, with an average rate +/- 2 breaths/min from the stated target considered within goal range. Descriptive statistics were used to summarize data.

Results: Among 107 survey respondents, perceptions of appropriateness, acceptability, and feasibility of the ventilation metronome were adequate. The final prototype utilizes a bell sound for high saliency in noisy environments and a scrolling timed vertical bar, with options for guideline-recommended CPR ventilation rates (10/min for adults, 20/min for older children, 30/min for infants). In usability testing (3 groups, 30 clinicians), median SUS was 92.5 (IQR 89.4, 93.1; maximum possible 100), with 0 attributable errors. Of 36 epochs of simulated CPR with concurrent ventilation metronome use, 34 (94%) had ventilation rates within 2 breaths/min of the metronome target.

Conclusions: Utilizing human factors engineering and implementation science principles, we successfully designed a novel digital audiovisual ventilation rate metronome with high usability scores and a considerably higher proportion of CPR epochs with ventilation rates within goal range than has been described in the pediatric cardiac arrest literature. We have implemented the metronome in a PICU pilot with ongoing data collection to determine its impact on delivery of guideline-compliant CPR ventilation rates.