AR-CPR: Refinement and Large-Scale Simulation-Based Testing of a Novel Augmented Reality Point of Care Chest Compression Feedback System.

每年，美国有2万名儿童心脏骤停，但只有17%-50%的儿童存活下来。生死存亡 与高质量的胸腔按压有关。然而，医疗保健提供者坚持速度和深度 儿科高级生命支持(PALS)计划推荐的心肺功能指南 复苏(CPR)在20%-40%的情况下非常糟糕。高质量胸外按压成功率提升至 配备高质量的心肺复苏(QCPR)教练(队友实时反馈胸部按压表现)。 虽然有效，但qCPR培训是资源和人员密集型的，限制了其在院前或社区的使用。 大多数心脏骤停儿童需要护理的环境。 在不增加人员的情况下提供实时CPR反馈的一种新策略是使用视觉 通过增强现实(AR)在医疗提供者的视野中提供反馈。一种名为AR的AR反馈系统 CPR已被证明可以实时改善胸部按压质量，具有良好的实用性和可行性。 来自34名受试者的数据证明了头盔显示器提供即时视觉心肺复苏的可行性 反馈，并将PALS对胸部按压比率和深度目标的忠诚度从没有达到17%提高到73% 反馈。虽然这些数据很有希望，但重大的发展和证据差距仍然存在。 因此，这项建议的R21目标是精炼AR-CPR，以获得准确和精确的速度和深度 测量(R21-目标1a)、增强可用性(R21-目标1b)、纳入后坐反馈(R21-目标1c)，以及 验证所有测量的准确性和精密度(R21-AIM 2)。本提案的R33目标是 基于非劣势的国际多中心随机模拟定量评价AR-CPR 与QCPR培训(R33-Aim 1)进行对比研究，并定性评估可用性和用户体验 (R33Aim 2)。据推测，这些改进将改善对PALS准则和 高质量CPR执行率，将AR-CPR定位为最有效的儿科CPR反馈系统 可用。拟议的研究将作为一项多学科合作进行，研究人员将在 约翰霍普金斯大学医学院，约翰霍普金斯大学应用物理实验室，以及 基于模拟的国际儿科创新、研究和教育网络(INSPIRE)。 根据医疗研究和质量机构(AHRQ)的使命，这 该提案为完善和改进AR-CPR奠定了基础，使这一临床救命工具更容易 使用、可访问和负担得起，从而公平地支持医疗服务提供者提供更高的表现 各种临床环境下的高质量儿科心肺复苏。这项研究将解决两个长期关键目标：节省 通过在更低的地区广泛提供高质量的CPR，改善儿童的生活，解决护理提供中的不平等问题 资源设置，包括在每一家医院和救护车中，以及在 学校、机场、商场和家庭。

Each year, 20,000 children in the United States suffer a cardiac arrest, but only 17-50% survive. Survival is associated with high-quality chest compressions. Yet, healthcare providers adhere to the rate and depth guidelines recommended by the Pediatric Advanced Life Support (PALS) program for cardiopulmonary resuscitation (CPR) an abysmal 20-40% of the time. Rates of high-quality chest compressions improve to 64% with a quality CPR (qCPR) coach (a teammate giving real-time feedback on chest compression performance). While effective, qCPR coaching is resource and personnel intensive, limiting its use in prehospital or community settings where most children in cardiac arrest present for care. A novel strategy to provide real-time CPR feedback without additional personnel is the use of visual feedback in a medical provider's field of view through augmented reality (AR). An AR feedback system called AR- CPR has been shown to improve chest compression quality in real time, with promising usability and feasibility. Data from 34 subjects, demonstrate the feasibility of a head mounted display to offer instantaneous visual CPR feedback, and improved PALS adherence to chest compression rate and depth goals to 73%, from 17% without feedback. While these data are promising, significant development and evidence gaps remain. Therefore, the R21 aims of this proposal are to refine AR-CPR for accurate and precise rate and depth measurement (R21-Aim 1a), enhance usability (R21-Aim 1b), incorporate recoil feedback (R21-Aim 1c), and validate the accuracy and precision of all measurements (R21-Aim 2). The R33 aims of this proposal are to quantitatively evaluate AR-CPR in an international multicenter randomized simulation-based non-inferiority study as compared to qCPR coaching (R33-Aim 1) and qualitatively evaluate usability and user experience (R33Aim 2). It is hypothesized that these enhancements will improve the adherence to PALS guidelines and the rate of high-quality CPR performance, positioning AR-CPR as the most effective pediatric CPR feedback system available. The proposed research will take place as a multidisciplinary collaboration among investigators at The Johns Hopkins University School of Medicine, The Johns Hopkins University Applied Physics Laboratory, and the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE). In accordance with the mission of The Agency for Healthcare Research and Quality (AHRQ), this proposal lays the groundwork to refine and improve AR-CPR by making this clinical lifesaving tool easier to use, accessible, and affordable and thus equitably supporting providers at the point of care to perform higher quality pediatric CPR in various clinical settings. This research will address two long term key goals: saving children's lives and addressing inequities in care delivery by making high quality CPR widely available in lower resource settings including in every hospital and ambulance, and with all automated external defibrillators in schools, airports, malls, and households.