JMIR Publications

ABSTRACT

Background:

The incidence of cardiac arrests per year in the United States continues to increase, yet in-hospital cardiac arrest survival rates significantly vary between hospitals. Current methods of face-to-face training are expensive, time consuming, and difficult to scale, which necessitates improvements in ACLS training aimed at improving patient survival. Virtual Reality (VR) has been proposed as an alternative or adjunct to high fidelity simulation (HFS) in several environments. Although it has been studied in the realm of ACLS education, no evaluations to date have explored the ability of a VR program to examine both technical and behavioral skills as well as demonstrate a cost comparison. Additionally, prior studies involving VR applications in ACLS education relied on additional peripheral devices and did not utilize a fully immersive VR environment.

Objective:

Evaluate the feasibility, human factor impact, and cost of a voice based VR ACLS refresher course as compared to high fidelity simulation.

Methods:

This prospective observational study performed at an academic institution consisted of 25 PGY-2 residents. Participants were randomized to high fidelity simulation or virtual reality training, and then crossed groups after a two-week washout. Participants were graded on technical and non-technical skills. Proctors were assessed for fatigue and task saturation and cost analysis based on local economic data were performed.

Results:

Of 25 participants, 23 were included in the scoring analysis. Less participants were familiar with VR compared to high fidelity simulation (36% vs 100% p<0.001). Neither modality was overtly preferred, however significantly more participants felt high fidelity simulation provided better feedback (99 [89-100] vs 79 [71-88], p<0.001). Scores were higher in the high fidelity simulation group, however, non-technical scores for decision making and communication were not significantly different between modalities. VR sessions were 21 [19-24] minutes shorter than high fidelity simulation, NASA task load index scores for proctors were lower in each category, and VR sessions were estimated to be $103.68 less expensive in a single learner single session model.

Conclusions:

Utilization of a VR based refresher for ACLS skills is comparable to high fidelity simulation in several areas. The VR module was more cost effective and was easier to proctor, however, high fidelity simulation was better at delivering feedback to participants. Further studies are needed to examine the utility of VR based environments at scale.