A prospective evaluation of the 'C.O.A.C.H.E.D.' cognitive aid for emergency defibrillation

Andrew Coggins; Cameron Nottingham; Melissa Chin; Sandra Warburton; Matthew Han; Margaret Murphy; Jeremy Sutherland; Nathan Moore

doi:10.1016/j.auec.2018.08.002

A prospective evaluation of the 'C.O.A.C.H.E.D.' cognitive aid for emergency defibrillation

Australas Emerg Care. 2018 Aug;21(3):81-86. doi: 10.1016/j.auec.2018.08.002. Epub 2018 Sep 10.

Authors

Andrew Coggins¹, Cameron Nottingham², Melissa Chin³, Sandra Warburton³, Matthew Han³, Margaret Murphy⁴, Jeremy Sutherland⁴, Nathan Moore⁵

Affiliations

¹ Emergency Department, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Simulated Learning Environment for Clinical Training (SiLECT), Sydney, Australia. Electronic address: andrew.coggins@health.nsw.gov.au.
² Sydney Medical School, University of Sydney, Sydney, Australia.
³ Simulated Learning Environment for Clinical Training (SiLECT), Sydney, Australia.
⁴ Emergency Department, Westmead Hospital, Sydney, Australia.
⁵ Sydney Medical School, University of Sydney, Sydney, Australia; Simulated Learning Environment for Clinical Training (SiLECT), Sydney, Australia.

PMID: 30998882
DOI: 10.1016/j.auec.2018.08.002

Abstract

Introduction: International guidelines recommend that interruptions to chest compressions are minimised during defibrillation. As a result, some resuscitation educators have adopted a more structured approach to defibrillation. One such approach is the 'C.O.A.C.H.E.D.' cognitive aid (Continue compressions, Oxygen away, All others away, Charging, Hands off, Evaluate, Defibrillate or Disarm). To date, there are no studies assessing the use of this cognitive aid.

Methods: This study utilised an Emergency Department in situ simulated model of cardiac arrest. The defibrillator used was a proprietary R-Series (Zoll, PA, USA) connected to a CS1201 rhythm generator (Symbio, Beaverton, OR, USA). The study cohorts were interdisciplinary advanced life support (ALS) providers. Paired providers were enrolled in a mechanical CPR (M-CPR) training programme with no feedback related to defibrillation performance. As part of this 6-month programme, serial defibrillation performance was assessed. The outcome measures were the length of 'peri-shock' pause and 'safety' of defibrillation practice. Comparative statistical analysis using the Mann-Whitney U-test was made between groups of providers with 'correct use or near correct' or 'entirely incorrect or absent' use of the cognitive aid.

Results: The C.O.A.C.H.E.D. cognitive aid was applied correctly in 92 of 109 defibrillations. Providers with correct cognitive aid use had a median length of peri-shock pause time of 6.0s (IQR 5.0-7.0). Providers with 'entirely incorrect or absent' cognitive aid use had a peri-shock pause time of 8.0s (IQRF 6.6-10.0) (p≤0.001). No unsafe defibrillation practices were observed.

Conclusion: In this observational study of defibrillation performance, the use of the C.O.A.C.H.E.D. cognitive aid was associated with a significant decrease in the length of peri-shock pause. Therefore, we conclude that the use of a cognitive aid is appropriate for teaching and performing defibrillation.

Keywords: Cardiopulmonary resuscitation; Cognitive aid; Defibrillation; Education.

MeSH terms

Cardiopulmonary Resuscitation / methods
Cardiopulmonary Resuscitation / standards
Decision Support Techniques*
Electric Countershock / methods*
Electric Countershock / standards*
Emergency Service, Hospital / organization & administration
Guidelines as Topic
Humans
Prospective Studies
Teaching / standards
Teaching / trends
Western Australia