Arresto cardiaco: nuove modalità di simulazione come strumenti per ottimizzare l'educazione medica e la cura del paziente

Introduction. The challenge of Emergency Medicine is to guarantee optimal care in very complex and environmentally dependent situations. Within all acute events, cardiac arrest is the most dramatic event that could occur. Having tools for training, research and the validation of protocols and procedures is necessary. Simulation encompasses all of these aspects and could meet the challenge of increasingly good patient care. Aim. My main project was to develop new simulation modalities to improve training and research in cardiac arrest. Methods. 1) Holo-BLSD is an Augmented Reality self-instruction training system, in which a standard CPR manikin is “augmented” within an interactive virtual environment that reproduces realistic scenarios. During the experience, users were trained to use the device while being guided through an emergency simulation and, at the end, were asked to complete a survey to assess the usability of the Holo-BLSD. Subsequently we enrolled 58 volunteer first-year nursing students randomly split in two groups: 29 participants underwent a self- training with the Holo-BLSD tool, and 29 students (control group) were trained in a traditional instructor-led course. We analyzed the appropriateness of action learning. 2) This study is a multi-center randomized controlled three-arm trial based on simulation. The intervention arm tested the PediAppRREST app; the two control arms, instead, were allocated to the PALS pocket card and to no cognitive aid, respectively. All participants are residents in Pediatrics, Anesthesia and Intensive Care or Emergency Medicine. The primary outcome of the study is a score calculated according to the c-DEV15plus checklist, which represents the number of deviations from PALS guidelines performed by each team during the management of the simulated cardiac arrest scenario. Results. 1) Holo-BLSD was rated easy to use (mean 4.00, SD 0.94), and the trainees stated that most people would learn to use it very quickly (mean 4.00, SD 0.89). Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction (mean 3.84, SD 1.14) were judged positively, although some hand gesture recognition errors reduced the feeling of having the right level of control over the system (mean 3.40, SD 1.04). The average overall examiner scores of the two groups are rather close (39.48 for the traditional training group, 37.07 for the Augmented Reality training group, on a maximum score of 44) and their difference is not statistically significant. 2) This is an interim analysis of the trial, including a sample size equal to approximately 78% of the final sample; so far, 82 teams. The c-DEV15plus score, expressed as median (IQR), was 3.0 (2.0-4.0) in the intervention arm and 6.0 (4.0-7.0) and 6.0 (5.0-7.0) in the CtrlPALS+ and CtrlPALS- control arms, respectively (p<0.0001). The CPT score, a validated indicator of the resuscitation performance, showed an improvement trend in the intervention group, which is statistically significant (p=0.0059). The team leaders’ workload resulted similar in the three groups. With regards the time of the first compression and to first adrenaline administration, no statistically significant differences were shown between the study groups. RCP quality was suboptimal, with no significant statistical differences between the three groups. The usability of the app was good according to the System Usability Scale (median of 77.5). Conclusions. The different simulation modalities (AR and High fidelity) were used in both the training and research and showed good resultsIntroduction. The challenge of Emergency Medicine is to guarantee optimal care in very complex and environmentally dependent situations. Within all acute events, cardiac arrest is the most dramatic event that could occur. Having tools for training, research and the validation of protocols and procedures is necessary. Simulation encompasses all of these aspects and could meet the challenge of increasingly good patient care. Aim. My main project was to develop new simulation modalities to improve training and research in cardiac arrest. Methods. 1) Holo-BLSD is an Augmented Reality self-instruction training system, in which a standard CPR manikin is “augmented” within an interactive virtual environment that reproduces realistic scenarios. During the experience, users were trained to use the device while being guided through an emergency simulation and, at the end, were asked to complete a survey to assess the usability of the Holo-BLSD. Subsequently we enrolled 58 volunteer first-year nursing students randomly split in two groups: 29 participants underwent a self- training with the Holo-BLSD tool, and 29 students (control group) were trained in a traditional instructor-led course. We analyzed the appropriateness of action learning. 2) This study is a multi-center randomized controlled three-arm trial based on simulation. The intervention arm tested the PediAppRREST app; the two control arms, instead, were allocated to the PALS pocket card and to no cognitive aid, respectively. All participants are residents in Pediatrics, Anesthesia and Intensive Care or Emergency Medicine. The primary outcome of the study is a score calculated according to the c-DEV15plus checklist, which represents the number of deviations from PALS guidelines performed by each team during the management of the simulated cardiac arrest scenario. Results. 1) Holo-BLSD was rated easy to use (mean 4.00, SD 0.94), and the trainees stated that most people would learn to use it very quickly (mean 4.00, SD 0.89). Voice (mean 4.48, SD 0.87), gaze (mean 4.12, SD 0.97), and gesture interaction (mean 3.84, SD 1.14) were judged positively, although some hand gesture recognition errors reduced the feeling of having the right level of control over the system (mean 3.40, SD 1.04). The average overall examiner scores of the two groups are rather close (39.48 for the traditional training group, 37.07 for the Augmented Reality training group, on a maximum score of 44) and their difference is not statistically significant. 2) This is an interim analysis of the trial, including a sample size equal to approximately 78% of the final sample; so far, 82 teams. The c-DEV15plus score, expressed as median (IQR), was 3.0 (2.0-4.0) in the intervention arm and 6.0 (4.0-7.0) and 6.0 (5.0-7.0) in the CtrlPALS+ and CtrlPALS- control arms, respectively (p