Augmented Reality-Cardiopulmonary Resuscitation Support for Pediatric Resuscitation

This prospective, multicenter, international, randomized, unblinded, non-inferiority study evaluates an augmented reality cardiopulmonary resuscitation feedback system (AR-CPR) compared with traditional human-delivered quality CPR coaching during simulated pediatric cardiac arrest. The study uses a standardized 18-minute pediatric cardiopulmonary arrest simulation conducted across eight participating institutions in the United States and Canada. Participants are actively credentialed pediatric emergency department or intensive care unit nurses and clinical technicians with current Pediatric Advanced Life Support (PALS) certification and prior experience or training functioning as quality CPR coaches. Participants are organized into teams of one to three members and perform chest compressions on a standardized high-fidelity pediatric manikin during a simulated non-shockable cardiac arrest involving an intubated 7-year-old child. The simulation is limited to chest compression performance to isolate the effect of the feedback modality on CPR quality. Participants are randomized at the team level to one of two study arms. In the control arm, an experienced, trained CPR coach provides real-time, goal-directed feedback based on chest compression rate, depth, and recoil. In the intervention arm, participants use AR-CPR, a head-mounted augmented reality system that provides real-time visual feedback on these same CPR performance measures. AR-CPR displays numerical and visual feedback within the participant's field of view and provides escalating goal-directed guidance when CPR performance falls outside established targets. CPR performance data are collected using the same AR-CPR sensor system in both study arms to provide standardized objective measurement. The study evaluates whether CPR performance with AR-CPR is non-inferior to performance achieved with a trained human CPR coach. The primary measure of CPR performance is the percentage of compressions simultaneously meeting American Heart Association guideline targets for compression rate and depth. Additional assessments characterize other measures of CPR quality and participants' cognitive workload and experience with the augmented reality system.