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Cheng A, Fijacko N, Lockey A, Greif R, Abelairas-Gomez C, Gosak L, Lin Y. Use of augmented and virtual reality in resuscitation training: A systematic review. Resusc Plus 2024; 18:100643. [PMID: 38681058 PMCID: PMC11053298 DOI: 10.1016/j.resplu.2024.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 05/01/2024] Open
Abstract
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.
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Affiliation(s)
- Adam Cheng
- Department of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Simulation Research Program, Alberta Children’s Hospital, Canada
| | - Nino Fijacko
- Faculty of Health Sciences, University of Maribor, Maribor University Medical Centre, Maribor, Slovenia
| | - Andrew Lockey
- Emergency Department, Calderdale & Huddersfield NHS Trust, Halifax, UK
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Cristian Abelairas-Gomez
- Faculty of Education Sciences and CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
| | - Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Yiqun Lin
- KidSIM-ASPIRE Simulation Research Program, Alberta Children’s Hospital, University of Calgary, Canada
| | - the Education Implementation Team Task Force of the International Liaison Committee on Resuscitation (ILCOR)1
- Department of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, KidSIM-ASPIRE Simulation Research Program, Alberta Children’s Hospital, Canada
- Faculty of Health Sciences, University of Maribor, Maribor University Medical Centre, Maribor, Slovenia
- Emergency Department, Calderdale & Huddersfield NHS Trust, Halifax, UK
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- Faculty of Education Sciences and CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
- KidSIM-ASPIRE Simulation Research Program, Alberta Children’s Hospital, University of Calgary, Canada
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2
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Yoo S, Son MH. Virtual, augmented, and mixed reality: potential clinical and training applications in pediatrics. Clin Exp Pediatr 2024; 67:92-103. [PMID: 37232076 PMCID: PMC10839193 DOI: 10.3345/cep.2022.00731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has significantly impacted the field of medical training, necessitating innovative approaches to education and practice. During this period, the use of novel technologies like virtual reality (VR), augmented reality (AR), and mixed reality (MR) has become increasingly vital. These technologies offer the advantage of transcending the limitations of time and space, thus enabling medical professionals to access various personalized programs for both education and service delivery. This shift is particularly relevant in the realm of pediatric medicine, where traditional training and clinical methods face unique challenges. PURPOSE The primary aim of this study is to explore the application of VR, AR, and MR technologies in pediatric medical settings, with a focus on both clinical applications and the training of pediatric medical professionals. We aim to comprehensively search and review studies that have utilized these technologies in the treatment of pediatric patients and the education of healthcare providers in this field. METHODS Peer-reviewed articles published in PubMed, the Cochrane Library, ScienceDirect, Google Scholar, and Scopus from January 1, 2018, to March 1, 2023, were comprehensively searched. The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analyses) guidelines. Among the 89 studies, 63 investigated the clinical applications of VR (n=60) or AR (n=3) in pediatric patients, and 25 investigated the applications of VR (n=19), AR (n=5), or MR (n=1) for training medical professionals. RESULTS A total of 36 randomized controlled trials (RCTs) for clinical application (n=31) and medical training (n=5) were retrieved. Among the RCTs, 21 reported significant improvements in clinical applications (n=17) and medical training (n=4). CONCLUSION Despite a few limitations in conducting research on innovative technology, such research has rapidly expanded, indicating that an increasing number of researchers are involved in pediatric research using these technologies.
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Affiliation(s)
- Suyoung Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Meong Hi Son
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kleinman K, Hairston T, Smith B, Billings E, Tackett S, Chopra E, Risko N, Swedien D, Schreurs BA, Dean JL, Scott B, Canares T, Jeffers JM. Pediatric Chest Compression Improvement Via Augmented Reality Cardiopulmonary Resuscitation Feedback in Community General Emergency Departments: A Mixed-Methods Simulation-Based Pilot Study. J Emerg Med 2023; 64:696-708. [PMID: 37438023 PMCID: PMC10360435 DOI: 10.1016/j.jemermed.2023.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/19/2023] [Accepted: 03/11/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Yearly, more than 20,000 children experience a cardiac arrest. High-quality pediatric cardiopulmonary resuscitation (CPR) is generally challenging for community hospital teams, where pediatric cardiac arrest is infrequent. Current feedback systems are insufficient. Therefore, we developed an augmented reality (AR) CPR feedback system for use in many settings. OBJECTIVE We aimed to evaluate whether AR-CPR improves chest compression (CC) performance in non-pediatric-specialized community emergency departments (EDs). METHODS We performed an unblinded, randomized, crossover simulation-based study. A convenience sample of community ED nonpediatric nurses and technicians were included. Each participant performed three 2-min cycles of CC during a simulated pediatric cardiac arrest. Participants were randomized to use AR-CPR in one of three CC cycles. Afterward, participants participated in a qualitative interview to inquire about their experience with AR-CPR. RESULTS Of 36 participants, 18 were randomized to AR-CPR in cycle 2 (group A) and 18 were randomized to AR-CPR in cycle 3 (group B). When using AR-CPR, 87-90% (SD 12-13%) of all CCs were in goal range, analyzed as 1-min intervals, compared with 18-21% (SD 30-33%) without feedback (p < 0.001). Analysis of qualitative themes revealed that AR-CPR may be usable without a device orientation, be effective at cognitive offloading, and reduce anxiety around and enhance confidence in the CC delivered. CONCLUSIONS The novel CPR feedback system, AR-CPR, significantly changed the CC performance in community hospital non-pediatric-specialized general EDs from 18-21% to 87-90% of CC epochs at goal. This study offers preliminary evidence suggesting AR-CPR improves CC quality in community hospital settings.
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Affiliation(s)
- Keith Kleinman
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland.
| | - Tai Hairston
- The Harriet Lane Pediatric Residency Program, The Johns Hopkins University, Baltimore, Maryland
| | - Brittany Smith
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Emma Billings
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Eisha Chopra
- Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Nicholas Risko
- Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Daniel Swedien
- Department of Emergency Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Blake A Schreurs
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, Laurel, Maryland
| | - James L Dean
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, Laurel, Maryland
| | - Brandon Scott
- The Johns Hopkins University Applied Physics Laboratory, LLC, The Johns Hopkins University, Laurel, Maryland
| | - Therese Canares
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Justin M Jeffers
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
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Weiss KE, Kolbe M, Nef A, Grande B, Kalirajan B, Meboldt M, Lohmeyer Q. Data-driven resuscitation training using pose estimation. Adv Simul (Lond) 2023; 8:12. [PMID: 37061746 PMCID: PMC10105636 DOI: 10.1186/s41077-023-00251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) training improves CPR skills while heavily relying on feedback. The quality of feedback can vary between experts, indicating a need for data-driven feedback to support experts. The goal of this study was to investigate pose estimation, a motion detection technology, to assess individual and team CPR quality with the arm angle and chest-to-chest distance metrics. METHODS After mandatory basic life support training, 91 healthcare providers performed a simulated CPR scenario in teams. Their behaviour was simultaneously rated based on pose estimation and by experts. It was assessed if the arm was straight at the elbow, by calculating the mean arm angle, and how close the distance between the team members was during chest compressions, by calculating the chest-to-chest distance. Both pose estimation metrics were compared with the expert ratings. RESULTS The data-driven and expert-based ratings for the arm angle differed by 77.3%, and based on pose estimation, 13.2% of participants kept the arm straight. The chest-to-chest distance ratings by expert and by pose estimation differed by 20.7% and based on pose estimation 63.2% of participants were closer than 1 m to the team member performing compressions. CONCLUSIONS Pose estimation-based metrics assessed learners' arm angles in more detail and their chest-to-chest distance comparably to expert ratings. Pose estimation metrics can complement educators with additional objective detail and allow them to focus on other aspects of the simulated CPR training, increasing the training's success and the participants' CPR quality. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kerrin E Weiss
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland.
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andrina Nef
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Institute of Anaesthesiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Bravin Kalirajan
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
| | - Quentin Lohmeyer
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, Zurich, 8092, Switzerland
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Interactive Teaching Aid Kit for Cardiopulmonary Resuscitation. Processes (Basel) 2022. [DOI: 10.3390/pr10081515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cardiopulmonary resuscitation (CPR) is an emergency procedure performed on a person experiencing cardiac arrest to manually preserve brain function until spontaneous breathing and blood circulation can be restored. If performed timely and properly, it can improve the survival rate of a person experiencing cardiac arrest. The promotion of CPR has always been an important task for countries around the world. Countries around the world often hold relevant study camps and seminars to improve the public’s awareness of CPR. On the basis of this rationale, this paper proposes an interactive teaching aid kit for CPR that uses a CPR manikin and tutoring software to facilitate CPR learning among trainees. The CPR manikin is equipped with sensors that determine whether the CPR steps are performed correctly. Data from the sensors are sent to the tutoring software through wireless transmission. The software provides video demonstrations and textual instructions concerning the standard CPR procedure. In this software, the interactive interface displays real-time information about the trainee’s CPR process, such as information on the CPR step being performed and the number of chest compression and breaths given. Thus, this teaching aid kit allows trainees to learn CPR without an instructor. This system may enable CPR to become a readily learnable skill for the general population.
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