Augmented Reality to Support Cardiopulmonary Resuscitation

The primary outcome is the time in seconds to first dose of epinephrine administration

The time in seconds from the investigator's clinical statement to initiation of chest compression

The time in seconds from the investigator's clinical statement to each manual defibrillator shock delivery

The time in seconds from the investigator's clinical statement to intravenous injection of epinephrine to treat underlying condition

The time in seconds from the investigator's clinical statement to intravenous injection of amiodarone to treat underlying condition

The time in seconds from the investigator's clinical statement to the successful establishment of a definitive airway via endotracheal intubation

Errors in drug dose administration (milligrams), defined as a deviation from the correct weight-based dose of more than 10% according to predefined, expert consensus-based criteria, will be measured (i.e., absolute and percentage deviation) in each allocation group as a deviation from the 2020 AHA Pediatric Advanced Life Support cardiac arrest algorithm.

The nature of the error type will be recorded, such as incorrect drug selection (i.e., administering the wrong medication), administration timing errors (i.e., administering the medication at the wrong time during the resuscitation process), labeling errors (i.e., misinterpreting or misreading the medication label), equipment-related errors (i.e., issues related to the functioning or availability of equipment needed for drug administration [e.g., syringe malfunction]), and documentation errors (i.e., inaccurate or incomplete recording of medication administration details)

Number of times medication errors occur during the cardiac arrest scenario

Number of times of cardiopulmonary resuscitation pauses during the cardiac arrest scenario

The total time in seconds of cardiopulmonary resuscitation pauses during the cardiac arrest scenario

The causes leading to resuscitation interruptions will be identified and documented

The proportion of cardiopulmonary resuscitation administrations that meet the predefined AHA standards for high-quality resuscitation techniques.

The fraction of time in seconds that chest compressions are being performed over the total cardiopulmonary resuscitation duration

The length of time in seconds between the cessation of chest compressions and the delivery of a defibrillation shock during cardiopulmonary resuscitation

Assessed via NASA-TLX. It measures mental burden across 6 dimensions: mental, physical, temporal demands, performance, effort, and frustration. Scores range from 0 to 100 in 5-point increments (0: no task load; 100: maximal task load). Participants rate each dimension based on their perceived workload. To combine the dimensions into a final score, a weighting procedure is used. This involves comparing each dimension with every other dimension to determine its relative importance in influencing workload. Participants select the dimension that contributes most to workload in each pair of comparisons. Each dimension is then weighted based on the participant's selections, with higher weights given to dimensions that are chosen more frequently. The weighted scores for each dimension are summed to calculate the overall score, which ranges from 0 (minimal task load) to 100 (maximal task load)

UEQ is a widely used questionnaire to measure the subjective impression of users towards the user experience of products. The UEQ is a semantic differential with 26 items that are grouped into six scales (Attractiveness, Perspicuity, Efficiency, Dependability, Stimulation, and Novelty). Each scale represents a distinct usability quality aspect. The minimum value is 0 (i.e., the worst user experience) and the maximum value is 100 (i.e., the best user experience). Participants will be asked to complete the UEQ directly after they have completed the resuscitation scenario

SUS is a widely used questionnaire for assessing the perceived usability of a system or product. The SUS consists of a 10-item questionnaire where users rate their agreement or disagreement with a series of statements regarding the usability of a system using a 5-point Likert scale (1 to 5). The minimum value is 0 (i.e., the system is not usable) and the maximum value is 100 (i.e., the system is absolutely usable). Participants will be asked to complete the SUS directly after they have completed the resuscitation scenario

The UTAUT consists of eight domains (performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, price value, habit, and behavioural intention). This measure will be adapted to assess participants' perceived usability, usefulness, and intention to use the augmented reality-aided tool after study completion. Responses are rated on a 7-point likert scale from 1=Strongly disagree to 7=Strongly agree. Participants will be asked to complete the UTAUT directly after they have completed the resuscitation scenario

This questionnaire is composed of 20-item self-report subscales to measure the temporary state of anxiety at the time of reporting (STAI form Y-1), which can be affected by stressful situations. Each item is answered on a 4-point Likert scale ranging from 1 (not at all) to 4 (very much). After reversing the scores for stress-absent items (ie, items 1, 2, 5, 8, 10, 11, 15, 16, 19, and 20), the total score is calculated by summing up the weighted scores for the 20 items. STAI ranges from 20 to 80, with higher scores being positively correlated with greater stress. The range of possible scores range from a minimum score of 20 to a maximum score of 80. STAI scores are commonly classified as "no or low anxiety" (20-37), "moderate anxiety" (38-44), and "high anxiety" (45-80). Participants will be asked to complete the STAI directly after they have completed the resuscitation scenario

Duration and number of visual fixations on pre-defined area of interest (AOI) for the team leader and medication nurse, as captured by the augmented reality device (Microsoft Hololens2). AOIs will include the holograms projected within each augmented reality device, as well as the LCD screen within the resuscitation room and manikin for the team leader.

The TEAM survey is a validated tool designed to assess team performance during emergency scenarios, focusing on non-technical skills. It consists of 11 items rated on a 5-point Likert scale (0 [Never/Hardly ever] to 4 [Always/Nearly always]) across three domains: Leadership, Teamwork, and Task Management, with an additional overall performance rating. Scores range from 0 (poor performance) to 44 (excellent performance), providing a comprehensive measure of team dynamics, communication, and coordination. Participants will complete the TEAM survey immediately after each resuscitation scenario to evaluate the team's effectiveness in managing the simulated IHCA

The CALM survey is a validated tool for assessing leadership in acute resuscitation scenarios, focusing on the Team Leader's performance. It includes 15 four-point Likert scale items (rarely, sometimes, mostly, always) across 4 domains-Leadership (role and style, 2 items), Communication (clarity and closed-loop reinforcement, 2 items), Team Management (role assignment, task direction, workload balance, team engagement, and case summarization, 5 items), and Medical Management (task prioritization, global awareness, patient reassessment, care planning, and help-seeking, 5 items)-plus 1 dichotomous behavioral item (yes/no on role announcement) and 1 global rating item comparing the leader to peers (below expected, as expected, above expected, top 5%). Scores for the Likert items range from 15 (poor leadership) to 60 (outstanding leadership), with additional binary and comparative assessments. Team members will complete the CALM survey immediately after each resuscitation scenario.