Aims and Objectives Pre-hospital Resuscitate Endovascular Balloon Occlusion of the Aorta (REBOA) is a time critical, complex and potentially life-saving procedure for patients with exsanguinating sub-diaphragmatic haemorrhage. The decision to perform REBOA and its technical complexities generate high levels of cognitive load. This study aimed to develop, validate and assess the feasibility of a novel pre-hospital REBOA cognitive load assessment tool.

Method and Design The novel Pre-hospital REBOA Cognitive Load Assessment (PROCLASS) Tool was developed from the NASA-TLX tool after a systematic review of the literature and input from domain experts. Feasibility of assessing cognitive load with the PROCLASS tool was assessed in a simulation study during standard pre-hospital REBOA training between February to April 2024. Dual assessment of cognitive load was undertaken using objective (heart rate variability (HRV)) and subjective (PROCLASS) measurements simultaneously. Ethical permission was granted by QMUL (IPREC280324.SIM).

Results and Conclusion The PROCLASS tool divides cognitive load into six domains: Mental Demand, Physical Demand, Temporal Demand, Performance, Situational Stress and Distractions. The domains are self-scored (0-100) and then multiplied by their relative ranking (0-5).

Five pre-hospital clinicians were enrolled, with a median duration of 5 years pre-hospital practice and 10 hours of REBOA training. PROCLASS analysis highlighted similarities in the domains of cognitive load between clinicians (figure 1). The objective assessment of cognitive load using HRV metrics showed increased sympathetic activation (four frequency domain variables) and decreased parasympathetic activation (three time domain variables).

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Abstract 2995 Figure 1

Congnitive load assessment using the bespoke PROCLASS tool

This study is the first to measure cognitive load in clinicians performing pre-hospital REBOA. Early findings confirm that PROCLASS is a viable tool for this purpose, providing granular data. PROCLASS can be easily combined with heart rate variability measurement. This approach could be used in future studies to identify individual steps of the procedure, that may benefit from further research or technological development to cognitively unburden the operator.