Impact of a Mobile App on Paramedics' Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial

Article Article scientifique Article Impact of a Mobile App on Paramedics' Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial eng 2021-10-07 author Lacour Matthieu Christian 0000-0003-0827-7496 858293 author Bloudeau Laurie 0000-0003-0754-2796 author Combescure Christophe 0000-0003-2631-4780 670542 author Haddad Kevin 0000-0002-3223-1810 author Hugon Florence Anne-Marie 0000-0003-4348-8352 74225 author Suppan Laurent 0000-0001-6989-6421 505697 author Rodieux Frédérique 0000-0002-8549-7997 778571 author Lovis Christian 0000-0002-2681-8076 29016 author Gervaix Alain 0000-0002-8925-5936 31715 author Ehrler Frédéric 0000-0001-9734-3242 509959 author Manzano Sergio 0000-0001-9603-5520 88371 author Siebert Johan 0000-0002-2871-3382 507348 collaborator Donnet Pascal 134669 collaborator Ottet Sebastien 593690 PedAMINES Prehospital Group e31748 10.2196/31748 34617916 2291-5222 PMC8532016 https://mhealth.jmir.org/2021/10/e31748 Background: Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. Objective: This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. Methods: In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants' self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants' heart rate with optical photoplethysmography. Results: From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory-perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference:-0.8, 95% CI-1.3 to-0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. Conclusions: Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. Trial registration: ClinicalTrials.gov <a href="http://clinicaltrials.gov/show/NCT03921346" rel="noopener noreferrer" target="_blank">NCT03921346</a>. State-Trait Anxiety Inventory Cardiopulmonary resuscitation Drugs Emergency medical services Medication errors Mobile apps Mobile health Out-of-hospital cardiac arrest Paramedics Pediatrics Stress Allied Health Personnel Cardiopulmonary Resuscitation Child Emergency Medical Services Emergency Service, Hospital Humans Infant Mobile Applications Dewey 613 Dewey 616.0757 Dewey 617 Dewey 618 Swiss National Science Foundation Reducing Prehospital Pediatric Medication Errors and Time to Drug Preparation and Delivery by EMS in Switzerland: a Multicenter, Prospective, Randomized Controlled Trial 32003B_182374 CH Project funding 64 Département de santé et médecine communautaires 22A 217 Centre de recherche clinique 201 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 62 Département de radiologie et informatique médicale 227 58 Département de pédiatrie, gynécologie et obstétrique 223 false 302 Groupe Desmeules Jules (pharmacologie/toxicologie) 567 344 Interfaces Homme-machine en milieu clinique 610 149 Etiologie des pneumonies et marqueurs inflammatoires chez l'enfant fébrile 183 JMIR mhealth and uhealth 9 10 dd979524-9753-42d4-8e14-b0c93790c144 Article (Published version) Public Article-scientifique-from-unpaywall.pdf 657022 application/pdf CC BY-4.0 96ef6049-3f1a-4299-98e7-2e0c31434f49 Appendix Public mhealth_v9i10e31748_app1.docx 17392 application/vnd.openxmlformats-officedocument.wordprocessingml.document 4827fa8b-8143-48bc-bf3a-2a959832d145 Appendix Public mhealth_v9i10e31748_app2.docx 16197 application/vnd.openxmlformats-officedocument.wordprocessingml.document openAccess Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires Faculté de médecine / Centre de recherche clinique Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique

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Impact of a Mobile App on Paramedics' Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial	JMIR mhealth and uhealth			2021	817	310

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