Creating an effective cognitive aid for advanced life support training and maximising efficiency in resuscitation

A closer look at cognitive aids in resuscitation

The Australian and New Zealand Committee on Resuscitation (ANZCOR) have recently updated their advanced life support (ALS) algorithm.  This is the first update since January 2016, and despite some recent updates in the resuscitation guidelines, the algorithm remains essentially unchanged. 

It is well researched that cognitive aids can enhance the function of the team by supporting a shared mental model, and reducing the cognitive load of the team leader. 

In high-stress situations, like cardiac arrests or other life-threatening emergencies, healthcare professionals must make rapid, accurate decisions.  The ALS algorithm serves as a cognitive anchor, reducing the cognitive load on the team leader and promoting a shared mental model among team members.  This shared understanding ensures that each team member knows their role, understands the steps being taken, and can anticipate what comes next.  By providing a clear, structured approach to emergencies, the ALS algorithm significantly enhances team coordination and efficiency.

Reducing cognitive load and enhancing team performance

Cognitive load theory suggests that our working memory has limited capacity.  During complex emergency procedures, the cognitive load on a team leader can be overwhelming, leading to errors or delays in decision-making. The ALS algorithm, with its clear, step-by-step approach alleviates this burden.  It allows the team leader to focus on critical aspects of patient care without being bogged down by the multitude of details that emergency situations present.  This clarity not only aids in making timely decisions but also ensures that these decisions are based on the best available evidence and practices.

Utilisation of the ALS algorithm as a cognitive aid

Cognitive aids are tools or strategies designed to support memory and decision-making in complex situations.  In the context of ALS, these aids include flowcharts, checklists and algorithms that provide a structured approach to emergency care.

A good cognitive aid in healthcare, particularly in high-pressure scenarios like ALS, possesses several key characteristics.  It must be clear and concise, allowing for quick reference without overwhelming the user with information.  The aid should be logically organised following the natural flow of decision-making in emergency situations.  Accessibility is crucial; it should be easy to use and available when needed.  Additionally, a good cognitive aid is evidence-based, incorporating the latest medical guidelines and best practices. Importantly, it should be adaptable, able to be tailored to different scenarios while maintaining its core functional integrity.  Above all, a good cognitive aid enhances efficiency, supports decision-making, and contributes to improved patient outcomes.

Optimising the flow of resuscitation

In the high-stakes world of resuscitation a good ALS cognitive aid will optimise the flow of the resuscitation.  This should include:

• Actions for shockable and non-shockable pathways

• Administration timing for first line drugs including Adrenaline & antiarrhythmics

• Guidance for pathway of action when patients move between the two sides of the algorithm

• Prompts for common reversible causes i.e. 4Hs & 4Ts

• Priorities in post resuscitation cares to optimise outcome  

Cognitive aids are invaluable in both ALS training and emergency situations.  They enhance learning, support decision-making, and ensure consistency in the application of life-saving techniques.  As Australian healthcare continues to evolve, the role of cognitive aids in ALS will remain crucial in saving lives and improving patient outcomes.

Accessing cognitive aids - supporting ALS training & patient care

The focus of Medcast resuscitation courses is to develop cognitive aids not just as theoretical tools, but practical necessities that can be used during training and clinical practice to optimise outcomes. This includes incorporation of instructional direction to provide guidance through the algorithm for situations where patients may start in an initial rhythm (e.g. shockable side of the algorithm) and progress to an alternate rhythm (e.g. non-shockable side of the algorithm). Providing instructional guidance for team leaders to follow reduces the cognitive load during the resuscitation improving capacity including non-technical skills like prioritisation and situational awareness. 

All cognitive aids used during Medcast ALS and PALS courses are available for download and use in clinical practice, with the aim to enhance learning, support decision-making, and ensure consistency in the application of life-saving techniques.

Further learning and references

Related courses

• Advanced Life Support (ALS) Course
• Paediatric Advanced Life Support (PALS) Course
• Critical Bytes Ready to Resus Course
• Lunch & Learn Reversible Causes of Arrest Course

References

1. ANZCOR Adult Advanced Life Support Flowchart (2023)

2. ILCOR Summary Statement (2022). Resuscitation, 181 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces (resuscitationjournal.com)