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Original research
Impact of visual distraction on neonatal mask ventilation: a simulation-based eye-tracking study
  1. Katharina Bibl1,
  2. Michael Wagner1,
  3. Robyn Dvorsky1,
  4. Moritz Haderer1,
  5. Vito Giordano1,
  6. Peter Groepel2,
  7. Angelika Berger1,
  8. Travis Whitfill3,
  9. Bashar Kadhim4,
  10. Marc A Auerbach3,
  11. Isabel T Gross3
  1. 1 Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
  2. 2 Division of Sport Psychology, Department of Sport Science, University of Vienna, Vienna, Austria
  3. 3 Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  4. 4 Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Katharina Bibl; katharina.bibl{at}meduniwien.ac.at

Abstract

Objective This study aimed to investigate whether distractions during simulated neonatal resuscitation impact mask leakage and visual gaze patterns during positive pressure ventilation (PPV) of a newborn manikin.

Study design In this observational, simulation-based study, medical students and paediatric residents managed a neonate requiring resuscitation alongside a standardised team and executed PPV on a leak-free manikin. The scenario incorporated distractions such as chest compressions, preparation and insertion of an umbilical vein catheter, administering fluids and interpreting venous blood gas. Ventilation parameters were monitored using a respiratory function monitor, and participants were equipped with eye-tracking glasses to assess visual gaze patterns. Additionally, they self-assessed their level of distractions and estimated performance. Measures included dwell time, mask leak, minute volume and respiratory rate to determine whether PPV parameters and distractors were associated during times of interest (TOI).

Results We included 30 participants and observed statistically significant differences in the delivery of PPV parameters between TOIs with distractions compared with TOIs without distractions, as reflected in mask leak (31.0 vs 15.9 %), minute volume (202.0 vs 253.0 mL/kg/min) and respiratory rate (29.0 vs 33.0/min). Results on alterations in gaze behaviour showed a significant gaze shift from the infant’s chest and airway to instruments and other areas of interest when distractions were present. During the venous blood gas interpretation, participants rated their performance worse than during other TOIs. Participants generally overrated their ventilation quality.

Conclusion This study showed a significant impact of distractions on PPV parameters and visual attention during simulated neonatal resuscitation.

  • Neonatology
  • Resuscitation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/archdischild-2024-327483

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors KB accepts full responsibility for the overall content of this article as guarantor. She had access to all the data, oversaw the conduct of the study, and controlled the decision to publish. KB and ITG conceptualised and designed the study, developed the study protocol, and formulated the research questions. KB, ITG, MW, TW and PG were responsible for data collection. MW, TW and PG also contributed to designing the data collection instruments. RD and MH performed the initial data analyses. KB and ITG drafted the initial manuscript. All authors critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This study was supported by the International Network for Simulation-based Pediatric Innovation, Research, & Education (INSPIRE) through the Patient Safety or Human Factors Award 2020 (Grant ID: GR109846 MPEDI IG INSPIRE), with an awarded amount of $30,000. The funding source had no role in the study design, data collection, analysis, interpretation or writing of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.