# A scoping review of cognitive load assessment tools suitable for clinicians performing REBOA

## TL;DR

This study reviews tools to measure cognitive load in clinicians performing REBOA and suggests the NASA-TLX and HRV as suitable options.

## Contribution

The study proposes a REBOA-adapted version of the NASA-TLX for post-procedure cognitive load assessment.

## Key findings

- The NASA-TLX was the most frequently used and highest-scoring subjective cognitive load tool for REBOA.
- HRV was the most common objective measure and scored well for REBOA use.
- A modified NASA-TLX tailored for REBOA is suggested for post-procedure assessment.

## Abstract

The ability to measure a clinician’s cognitive load allows task adaptions to optimise performance. The aim of this study was to identify cognitive load tools suitable for use by pre-hospital clinicians performing REBOA and develop a bespoke pre-hospital REBOA cognitive load assessment tool.

A scoping review was conducted, following the PRISMA guidelines, to identify different cognitive load assessment tools in the literature from inception to January 2023. A qualitative narrative synthesis was used to compare tools based on their type, frequency of use, and context. Tools were assessed for contextual relevance and practical application to REBOA using defined criteria (CMTA-R score), created using domain experts.

Forty-nine articles were included for review, identifying 21 unique cognitive load tools: 10 subjective and 11 objective. The NASA-TLX was the most frequently used subjective tool (17 studies), scoring highest for potential REBOA use (CMTA-R 17). Heart Rate Variability (HRV) was the most common objective measure (14 studies), with a CMTA-R score of 13. A bespoke REBOA modification of the NASA-TLX, was suggested to quantify post-procedure cognitive load.

This scoping review identifies the NASA-TLX and HRV as potential tools for assessing cognitive load during prehospital REBOA. A bespoke REBOA-adapted NASA-TLX, could be used post-procedure, while intra-procedural HRV monitoring could provide real-time data. Future research should validate this approach in clinical settings.

The online version contains supplementary material available at 10.1186/s13049-025-01408-0.