Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial

Abstract

BackgroundThe 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 availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses.ObjectiveThe study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards.MethodsWe conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario—pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines.ResultsTwenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other critical resuscitation endpoints and drug dose delivery were not improved using AR glasses. However, errors and deviations were significantly reduced in terms of defibrillation doses when compared with the use of the PALS pocket reference cards. In a total of 40 defibrillation attempts, residents not wearing AR glasses used wrong doses in 65% (26/40) of cases, including 21 shock overdoses >100 J, for a cumulative defibrillation dose of 18.7 Joules per kg. These errors were reduced by 53% (21/40, P<.001) and cumulative defibrillation dose by 37% (5.14/14, P=.001) with AR glasses.ConclusionsAR glasses did not decrease time to first defibrillation attempt and other critical resuscitation endpoints when compared with PALS pocket cards. However, they improved adherence and performance among residents in terms of administering the defibrillation doses set by AHA.

Augmented reality and mixed reality for healthcare education beyond surgery: an integrative review

“…41,47,48 Eight studies implemented headmounted display. 27,28,38,40,[43][44][45][46] Two studies utilized the same head-mounted display. 40,43 The head-mounted display-integrated applications had marker-based recognition in four of the studies.…”

“…30,37,39,40,42,43,50,51 The remaining studies (n=12) focused on the application-based assessment of a specific skill or procedure, eventually correlating the performance to other outcomes such as cognitive load. 27,31,36,38,41,[44][45][46]48,49,51,52 Technical test outcomes were reported in 17 studies and concerned primarily needle insertion in terms of accuracy and precision (n=11). [27][28][29]31,33,40,43,44,[50][51][52] The secondly most reported technical test outcome concerned procedure time (n=9).…”

“…27,29,38,43,44,46,[50][51][52] Nineteen studies investigated learning experience and user acceptance based on especially Likert scales. [30][31][32][34][35][36][37][38][39][40][41][42][44][45][46][47][48][49]52 Other questionnaire-based outcomes were cognitive load, stress response, adverse health effects and ergonomics. 38,39,41,[44][45][46] Knowledge tests were examined in combination with questionnaire-based outcomes in six studies.…”

“…[30][31][32][34][35][36][37][38][39][40][41][42][44][45][46][47][48][49]52 Other questionnaire-based outcomes were cognitive load, stress response, adverse health effects and ergonomics. 38,39,41,[44][45][46] Knowledge tests were examined in combination with questionnaire-based outcomes in six studies. 36,37,39,41,42,49 One study included an observational method to determine learning behavior.…”

Assessment of Google Glass for photographic documentation in veterinary forensic pathology (Preprint)

“…Glass to be tested in many medical and biomedical fields such as on-demand data visualization and real-time analysis [8], clinical simulations [9], management of diabetes [10], forensic medicine [5], pediatric cardiopulmonary resuscitation [11] and surgery [12,13]. Despite the many publications in human medicine, at the moment, no empirical evidence for using Google Glass in a veterinary medicine setting is known to the authors.…”