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Screenshot of a resuscitation step from the American Heart Association's Pediatric Advanced Life Support pulseless ventricular tachycardia algorithm as adapted in augmented reality glasses.
Source publication
Background:
The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availab...
Context in source publication
Context 1
... cards were tailored to the small size of the Google glass screen, following a user-centered and ergonomic-driven approach. Each card was structured on 4 zones: (1) a color-coded title allowing direct identification of each step in progress, (2) an image on the left helping with decision-making (such as distinctive illustration of cardiac rhythms), (3) a menu choice on the right helping to progress in the resuscitation steps, and (4) a footer to preview the next step ( Figure 2). Interaction was also defined with end users. ...
Citations
... En 2018, la American Heart Association destacó el papel de las tecnologías inmersivas como una estrategia educativa para la mejora del aprendizaje en temas de reanimación. Es reconocida como una herramienta importante de enfoque para la innovación, ya que llega a ser más atractiva para los alumnos y aumenta la retención de conocimientos, y también realiza retroalimentación en tiempo real, al mismo tiempo que facilita la práctica en escenarios en equipo 14,15 . ...
Resumen En los últimos años se han establecido centros de simulación médica especializados con el propósito de cultivar las habi-lidades esenciales para los médicos. Estos centros proporcionan entornos seguros de aprendizaje, empleando distintas herramientas para la realización de prácticas deliberadas y escenarios clínicos. Con el auge tecnológico, la realidad virtual y aumentada se ha desarrollado en distintos ámbitos, incluyendo el área de la salud. Diversos estudios han confirmado que las metodologías de aprendizaje activas generan un impacto positivo, facilitando una comprensión más profunda del con-tenido, un aumento en el aprendizaje y una retención a largo plazo. Además, fomentan la colaboración y la motivación en los estudiantes. En todo el mundo, y específicamente en México, el paro cardiorrespiratorio figura como una de las princi-pales causas de muerte. Este estudio se enfoca en explorar la aplicabilidad de la realidad virtual en la reanimación car-diopulmonar como una herramienta de enseñanza en simulaciones clínicas. Dada la capacidad de esta intervención para salvar vidas, es crucial que los estudiantes de medicina adquieran y dominen estas habilidades vitales. Palabras clave: Simulación clínica. Realidad virtual. Realidad aumentada. Reanimación cardiopulmonar. Educación. Metodología de enseñanza. Abstract In recent years, specialized medical simulation centers have been established with the purpose of nurturing essential skills for physicians. These centers provide secure learning environments, employing various tools for deliberate practices and clinical scenarios. With the technological surge, virtual and augmented reality have been developed in various fields, including the heal-thcare sector. Several studies have confirmed that active learning methodologies have a positive impact, facilitating a deeper understanding of content, an increase in learning, and long-term retention. Additionally, they foster collaboration and motivation among students. Globally, and specifically in Mexico, cardiorespiratory arrest stands out as a leading cause of mortality. This study focuses on exploring the applicability of virtual reality in cardiopulmonary resuscitation as a teaching tool in clinical simulations. Given the potential of this intervention to save lives, it is crucial for medical students to acquire and master these vital skills.
... bedside ultrasound, central line insertion) 6,10 and provide decision support and clinical prompts during actual resuscitative care. 38,39 We see these as exciting avenues for future resuscitation education research, where AR could potentially be used to improve acquisition of key procedural skills other than CPR, such as intubation, intraosseous needle insertion, and defibrillation. AR could also potentially be used to provide expert guidance via clinical prompts during resuscitation training, helping to reinforce quick and efficient decision making during cardiac arrest cases. ...
Objectives
To evaluate the effectiveness of augmented reality (AR) and virtual reality (VR), compared with other instructional methods, for basic and advanced life support training.
Methods
This systematic review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) and reported based on the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and registered with PROSPERO (CRD42023376751). MEDLINE, EMBASE, and SCOPUS were searched from inception to January 16, 2024. We included all published studies comparing virtual or augmented reality to other methods of resuscitation training evaluating knowledge acquisition and retention, skills acquisition and retention, skill performance in real resuscitation, willingness to help, bystander CPR rate, and patients’ survival.
Results
Our initial literature search identified 1807 citations. After removing duplicates, reviewing the titles and abstracts of the remaining 1301 articles, full text review of 74 articles and searching references lists of relevant articles, 19 studies were identified for analysis. AR was used in 4 studies to provide real-time feedback during CPR, demonstrating improved CPR performance compared to groups trained with no feedback, but no difference when compared to other sources of CPR feedback. VR use in resuscitation training was explored in 15 studies, with the majority of studies that assessed CPR skills favoring other interventions over VR, or showing no difference between groups.
Conclusion
Augmented and virtual reality can be used to support resuscitation training of lay people and healthcare professionals, however current evidence does not clearly demonstrate a consistent benefit when compared to other methods of training.
... Recently, some research groups implemented MR prototypes for adult life support training [12,[24][25][26][27]; they combine a non sensorized manikin, either half body or full body, with a Head Mounted Display (HMD), tracking devices (controllers, trackers, data gloves). Tools for paediatric resuscitation training are still limited to few serious games or AR applications [28][29][30]. Furthermore, to the best of our knowledge, no MR-based NLS tools are available so far, despite its unquestionable value [11,30]. ...
Neonatal resuscitation is an uncommon, albeit critical task that is more likely to succeed if performed properly and promptly. In this context, simulation is an appropriate way for training and assessing the abilities of all medical staff involved in delivery room care. Recent studies have shown that learning is enhanced if the simulation experience is realistic and engaging. Hence, Virtual Reality can be beneficial for newborn resuscitation training. However, the difficulty of providing realistic haptic interaction limits its use. To overcome this constraint, we have designed RiNeo MR, a simulator for newborn life support training, combining a sensorized manikin to monitor in real time resuscitation skills, with a Virtual Reality application. The system includes a Virtual Reality headset, Leap Motion to track the user’s hands, sensorized bag valve mask, and manikin to monitor head and mask positioning, ventilation, and chest compression. RiNeo MR can be used in two modalities: 2D to let the trainee practice resuscitation manoeuvres on the physical manikin, while receiving real time feedback; 3D that allows the user to be immersed in a virtual environment and practice in an hospital-like setting. In the 3D mode, virtual and real manikins are overlapped and communicate in real time. Tests on 16 subjects (11 controls without medical expertise and 5 paediatric residents) demonstrated that the simulator is well tolerated in terms of discomfort. Moreover, the simulator is high rated for user experience and system usability, suggesting that RiNeo MR can be a promising tool to improve newborn life support training. RiNeo MR is a proof of concept of a mixed-reality newborn life support simulator that can be a promising tool to spread newborn resuscitation high-quality training among healthcare providers involved in perinatal medicine.
... Thus, identifying technologies that can improve adherence to ACLS protocols and in turn, cardiac arrest outcomes, is critical. Cognitive aids, such as pocket cards, mobile apps, and augmented reality glasses, have been shown to increase adherence to ACLS guidelines and the quality of resuscitation in adult simulations for in-hospital cardiac arrests [23][24][25][26][27][28]. ChatGPT could prove to be a valuable resource by providing real-time decision support in resource-limited settings or augmenting clinical decision-making. ...
Background
ChatGPT is the most advanced large language model to date, with prior iterations having passed medical licensing examinations, providing clinical decision support, and improved diagnostics. Although limited, past studies of ChatGPT’s performance found that artificial intelligence could pass the American Heart Association’s advanced cardiovascular life support (ACLS) examinations with modifications. ChatGPT’s accuracy has not been studied in more complex clinical scenarios. As heart disease and cardiac arrest remain leading causes of morbidity and mortality in the United States, finding technologies that help increase adherence to ACLS algorithms, which improves survival outcomes, is critical.
Objective
This study aims to examine the accuracy of ChatGPT in following ACLS guidelines for bradycardia and cardiac arrest.
Methods
We evaluated the accuracy of ChatGPT’s responses to 2 simulations based on the 2020 American Heart Association ACLS guidelines with 3 primary outcomes of interest: the mean individual step accuracy, the accuracy score per simulation attempt, and the accuracy score for each algorithm. For each simulation step, ChatGPT was scored for correctness (1 point) or incorrectness (0 points). Each simulation was conducted 20 times.
Results
ChatGPT’s median accuracy for each step was 85% (IQR 40%-100%) for cardiac arrest and 30% (IQR 13%-81%) for bradycardia. ChatGPT’s median accuracy over 20 simulation attempts for cardiac arrest was 69% (IQR 67%-74%) and for bradycardia was 42% (IQR 33%-50%). We found that ChatGPT’s outputs varied despite consistent input, the same actions were persistently missed, repetitive overemphasis hindered guidance, and erroneous medication information was presented.
Conclusions
This study highlights the need for consistent and reliable guidance to prevent potential medical errors and optimize the application of ChatGPT to enhance its reliability and effectiveness in clinical practice.
... Several educational strategies and novel technologies have been designed to assist healthcare providers in improving their adherence to guidelines for the management of CA [24][25][26][27][28][29]. Recently, different cognitive aids, in the format of paper-based and digital resources, have been developed for both lay rescuers and healthcare providers to support the management of OHCA and IHCA [30][31][32][33][34][35][36][37][38][39][40]. Systematic reviews on audio/video guidance and smartphone applications (apps) developed to support bystanders in managing OHCA showed that the use of these tools was associated with improved quality of bystanders' cardiopulmonary resuscitation (CPR) [39][40][41]. ...
... Of the 4224 screened studies, 16 met our inclusion criteria: 14 adult CA studies [32][33][34][35][36][48][49][50][51][52][53][54][55][56] (for a total of 688 scenarios) and two paediatric CA studies [30,31] (for a total of 46 scenarios). The PRISMA flow chart for the study selection process is shown in Fig. 1. ...
... The characteristics of the two included paediatric studies [30,31] are reported in Table 1. Both were recent RCTs conducted by the same research team and evaluated pVT scenarios managed by paediatric residents. ...
Different cognitive aids have been recently developed to support the management of cardiac arrest, however, their effectiveness remains barely investigated. We aimed to assess whether clinicians using any cognitive aids compared to no or alternative cognitive aids for in-hospital cardiac arrest (IHCA) scenarios achieve improved resuscitation performance. PubMed, EMBASE, the Cochrane Library, CINAHL and ClinicalTrials.gov were systematically searched to identify studies comparing the management of adult/paediatric IHCA simulated scenarios by health professionals using different or no cognitive aids. Our primary outcomes were adherence to guideline recommendations (overall team performance) and time to critical resuscitation actions. Random-effects model meta-analyses were performed. Of the 4.830 screened studies, 16 (14 adult, 2 paediatric) met inclusion criteria. Meta-analyses of eight eligible adult studies indicated that the use of electronic/paper-based cognitive aids, in comparison with no aid, was significantly associated with better overall resuscitation performance [standard mean difference (SMD) 1.16; 95% confidence interval (CI) 0.64; 1.69; I ² = 79%]. Meta-analyses of the two paediatric studies, showed non-significant improvement of critical actions for resuscitation (adherence to guideline recommended sequence of actions, time to defibrillation, rate of errors in defibrillation, time to start chest compressions), except for significant shorter time to amiodarone administration (SMD − 0.78; 95% CI − 1.39; − 0.18; I ² = 0). To conclude, the use of cognitive aids appears to have benefits in improving the management of simulated adult IHCA scenarios, with potential positive impact on clinical practice. Further paediatric studies are necessary to better assess the impact of cognitive aids on the management of IHCA scenarios.
... A total of 68 studies were downloaded and evaluated via full-text screening, of which 55 were excluded for various reasons ( Figure 1). Finally, 13 studies with a total of 654 participants were eligible for the meta-analysis; 2 studies used the same set of participants for both the control and AR groups [25,26], while another 6 studies [27][28][29][30][31][32] that also measured both the control and AR groups divided the sample size. ...
... As presented in Table 1, the trials of the selected studies were performed in the following ten countries: Germany [27,28,30], the United States [24,31], the United Kingdom [33], Canada [34], Italy [35], Sweden [26], Finland [32], Switzerland [29], Spain [36], and South Korea [25]. Furthermore, 10 of the 13 studies, adopted a randomized control trial [24,[26][27][28][29][32][33][34][35][36], 2 studies had a mixed design [30,31], and 1 study used a cohort approach [25]. ...
... As presented in Table 1, the trials of the selected studies were performed in the following ten countries: Germany [27,28,30], the United States [24,31], the United Kingdom [33], Canada [34], Italy [35], Sweden [26], Finland [32], Switzerland [29], Spain [36], and South Korea [25]. Furthermore, 10 of the 13 studies, adopted a randomized control trial [24,[26][27][28][29][32][33][34][35][36], 2 studies had a mixed design [30,31], and 1 study used a cohort approach [25]. The number of participants in the studies ranged between 4 and 372. ...
Background
Augmented reality (AR) is an interactive technology that uses persuasive digital data and real-world surroundings to expand the user's reality, wherein objects are produced by various computer applications. It constitutes a novel advancement in medical care, education, and training.
Objective
The aim of this work was to assess how effective AR is in training medical students when compared to other educational methods in terms of skills, knowledge, confidence, performance time, and satisfaction.
Methods
We performed a meta-analysis on the effectiveness of AR in medical training that was constructed by using the Cochrane methodology. A web-based literature search was performed by using the Cochrane Library, Web of Science, PubMed, and Embase databases to find studies that recorded the effect of AR in medical training up to April 2021. The quality of the selected studies was assessed by following the Cochrane criteria for risk of bias evaluations.
ResultsIn total, 13 studies with a total of 654 participants were included in the meta-analysis. The findings showed that using AR in training can improve participants' performance time (I2=99.9%; P
... This could make learning faster, more efficient, and more engaging ( Geroimenko, 2020 ). Owing to the advantages that AR technology offers, several programs using available devices such as Google Glass and Microsoft Hololens2 have been successfully implemented in the field of CPR, and demonstrate its feasibility and usability ( Balian, McGovern, Abella, Blewer, & Leary, 2019 ;Ingrassia et al., 2020 ;Siebert et al., 2017 ). Furthermore, AR devices for self-training could reduce the need for group training, which is difficult to conduct in the context of the ongoing COVID-19 pandemic. ...
Background
A trained lay rescuer is the most important determinant of survival from sudden cardiac arrest. Augmented Reality (AR) device may represent a powerful instrument for CPR assistance and self-training especially during the COVID-19 pandemic.
Methods
A prospective, parallel, 1:1 pilot randomized clinical trial was designed. An AR CPR app was developed and 28 participants were randomly allocated into AR-assisted group and instructor-assisted group. Acceptability, usability, and mean per minute/per cycle chest compression depth, rate and accuracy were measured.
Results
The mean scores for acceptability and usability were all rated good in each group. Comparing real-time AR-assisted CPR to instructor-assisted CPR, the mean difference of compression depth was 0.18 (95% CI: -0.18-0.53) cm and rate was -1.58 (95% CI: -6.11-2.95) min-1. Comparing AR self-training to instructor training, the AR group was not significantly different between two groups regarding both compression depth, rate and accuracy (p > .05).
Conclusion
We found that the AR CPR app was an acceptable and usable tool both in real-time-assisted CPR and self-training CPR.
... In recent years the majority of research studies have focused on AR in emergency training designed applications, taking advantage of optical see-through AR devices like the Microsoft HoloLens and Google Glass ( Figure 2) [75,[81][82][83][84][85][86]. AR-based tools can be divided into (1) applications that assist a user who needs to perform a life-saving task [81,85] and (2) applications that augment the simulation experience with virtual elements, giving real-time performance feedback during training [75,82,83]. ...
... In recent years the majority of research studies have focused on AR in emergency training designed applications, taking advantage of optical see-through AR devices like the Microsoft HoloLens and Google Glass ( Figure 2) [75,[81][82][83][84][85][86]. AR-based tools can be divided into (1) applications that assist a user who needs to perform a life-saving task [81,85] and (2) applications that augment the simulation experience with virtual elements, giving real-time performance feedback during training [75,82,83]. The first group of tools aims at shortening the rescue time through cues appearing in an emergency setting. ...
... So far, in the latter context, experimental study results have been controversial. Siebert [81] compared the time required to provide defibrillation in two groups of pediatric residents. The first group could follow the pediatric advanced life support algorithm on a pocket reference card; the second group used Google Glasses to access the same information. ...
The use of augmented reality (AR) and virtual reality (VR) for life support training is increasing. These technologies provide an immersive experience that supports learning in a safe and controlled environment. This review focuses on the use of AR and VR for emergency care training for health care providers, medical students, and nonprofessionals. In particular, we analyzed (1) serious games, nonimmersive games, both single-player and multiplayer; (2) VR tools ranging from semi-immersive to immersive virtual and mixed reality; and (3) AR applications. All the toolkits have been investigated in terms of application goals (training, assessment, or both), simulated procedures, and skills. The main goal of this work is to summarize and organize the findings of studies coming from multiple research areas in order to make them accessible to all the professionals involved in medical simulation. The analysis of the state-of-the-art technologies reveals that tools and studies related to the multiplayer experience, haptic feedback, and evaluation of user’s manual skills in the foregoing health care-related environments are still limited and require further investigation. Also, there is an additional need to conduct studies aimed at assessing whether AR/VR-based systems are superior or, at the minimum, comparable to traditional training methods.
... To date, multiple studies have shown a significant reduction of errors and deviations and therefore improving adherence to guideline in different simulated resuscitation settings. [18][19][20][21][22] The use of augmented reality in medical applications has shown to be an effective and versatile technique as interactive images can be displayed in the user's field of view without a significant disturbance of normal vision. [23][24][25][26] In the field of neonatology, the use of augmented reality during simulated intubation has shown to be effective. ...
... Electronic decision support tools concerning simulated life-threatening or resuscitation scenarios have shown a significant improvement in adherence to guideline and reduction of errors and deviations. [18][19][20][21][22] Despite promising results, the adoption of eDSTs in clinical practice is still limited. Adoption of new technology or changes in long-standing routines often results in a temporarily increased user distraction or an additional required effort. ...
Introduction:
The Newborn Life Support (NLS) guideline aims to provide healthcare professionals a consistent approach during neonatal resuscitation. Adherence to this and analogous guidelines has repetitively been proven to be difficult.This study evaluates adherence to guideline using a novel augmented reality (Microsoft HoloLens) electronic decision support tool during standardized simulated neonatal resuscitation compared with subjects working from memory alone.
Methods:
In this randomized controlled pilot study, 18 professionals responsible for neonatal resuscitation were randomized to the intervention group and 11 to the control group. Demographic characteristics were similar between both groups. A standardized neonatal resuscitation scenario was performed, which was recorded and later assessed for adherence to the NLS algorithm by 2 independent reviewers. Secondary outcomes were error classification in case of algorithm deviation and time to the execution or completion of critical steps in the algorithm to determine delay.
Results:
Median (interquartile range) scores of a theoretical maximum of 40 in the intervention group were 34 (32.5-35.5) versus 29 (27-33) in the control group (P = 0.004). Errors of commission were committed less frequently with the electronic decision support tool 2 (1-2.5) compared with 4 (2-4) in the control group (P = 0.029). Analysis of time to initiation or completion of key steps in the NLS algorithm showed no significant differences between both groups.
Conclusions:
Healthcare professionals using an electronic decision support tool showed improved adherence to the NLS guideline during simulated neonatal resuscitation.
... They can manipulate the virtual on-site room and objects in it by hand-gestures or additional control devices. Areas in which such settings have been successfully applied include industrial maintenance [4,24], the provision of advice and finding objects [38,50], manual assembly tasks [18,26], crime scene investigation [17], remote furniture consultations [15,37] as well as support and training in healthcare [9,40,44] as discussed in this paper. In most of these scenarios, the remote user is some sort of helper or holds additional knowledge. ...
... However, they also found that caregivers preferred to take pictures on the smartphone, as it produced better image quality and enabled a preview. Siebert et al. [44] investigated the use of HMDs to guide life-saving activities such as defibrillation and found that the physicians in their studies performed the tasks as fast as colleagues using traditional support but adhered better to standards and made fewer mistakes. Prilla et al. [40] show how guidelines provided by HMDs can support caregivers during pain treatment. ...
... Regarding the literature, the main potentials of using HMDs in care are freeing the hands of users while providing information and guidance to the user (e.g., [1,44]) as well as enabling caregivers and others to use a first-person perspective of looking at a care setting [29,44]. The former is especially important for care, as caregivers need their hand to treat, move or support the patient. ...
Professional caregivers often face complex situations in which they need the support of a colleague or a specialist. This is especially necessary for caregivers during their training or with less practice in certain tasks. Due to time and space restrictions, colleagues or specialists are not always available for local support. Remote support by streaming videos to a remote helper has been discussed in healthcare domains as a so-called teleconsultation. However, little is known about how to apply teleconsultation in care. We conducted a study with caregivers and remote helpers to compare head mounted devices (HMDs) for teleconsultation in care to two alternative solutions using smartphones. We found that despite lacking familiarity, HMDs have good potential for remote support in care, and that creating video streams with smartphones is not preferable for teleconsultations. We suggest that ideal support needs to balance freedom and guidance and suggest how such support needs to be further explored.
