Abstract
PurposeEffective training of extracorporeal membrane oxygenation (ECMO) cannulation is key to fighting the persistently high mortality rate of ECMO interventions. Though augmented reality (AR) is a promising technology for improving information display, only a small percentage of AR projects have addressed training procedures. The present study investigates the potential benefits of AR-based, contextual instructions for ECMO cannulation training as compared to instructions used during conventional training at a university hospital.MethodologyAn AR step-by-step guide was developed for the Microsoft HoloLens 2 that combines text, images, and videos from the conventional training program with simple 3D models. A study was conducted with 21 medical students performing two surgical procedures on a simulator. Participants were divided into two groups, with one group using the conventional instructions for the first procedure and AR instructions for the second and the other group using instructions in reverse order. Training times, a detailed error protocol, and a standardized user experience questionnaire (UEQ) were evaluated.ResultsAR-based execution was associated with slightly higher training times and with significantly fewer errors for the more complex second procedure (p<0.05, Mann–Whitney U). These differences in errors were most present for knowledge-related errors, resulting in a 66% reduction in the number of errors. AR instructions also led to significantly better ratings on 5 out of the 6 scales used in the UEQ, pointing to higher perceived clarify of information, information acquisition speed, and stimulation.ConclusionThe results extend previous research on AR instructions to ECMO cannulation training, indicating its high potential to improve training outcomes as a result of better information acquisition by participants during task execution. Future work should investigate how better performance in a single training session relates to better performance in the long run.
Highlights
Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure for severe respiratory or cardiac failure that has evolved from a last-resort treatment to a more mainstreamSufficient training for ECMO cannulation in general is shown to be linked with decreasing mortality rates [14]
We evaluate augmented reality (AR) step-by-step instructions for ECMO cannulation training and compare them with the conventional training instructions regularly used at a university hospital
No participant reported having any previous experience with ECMO cannulation, though 9 participants had previous experience with other cannulation procedures
Summary
Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure for severe respiratory or cardiac failure that has evolved from a last-resort treatment to a more mainstream. Sufficient training for ECMO cannulation in general is shown to be linked with decreasing mortality rates [14]. Simulation-based training shows significant improvements for ECMO cannulations [2,6]. Frequent and realistic training seems to be key when it comes to successful ECMO procedures. Training is timeconsuming, and there is no standardized certification or training process for ECMO cannulations [6]. Since ECMO cannulations are often emergency operations, a physician can go months or years without having to perform an ECMO cannulation before suddenly being confronted with a time-critical situation [19]. To be able to act precisely and quickly, physicians need to be provided with frequent and thorough training
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