Introduction: Investigators conducted a prospective experimental study to evaluate the effectof team size and recovery exercises on individual providers’ compression quality and exertion.Investigators hypothesized that 1) larger teams would perform higher quality compressions withless exertion per provider when compared to smaller teams; and 2) brief stretching and breathingexercises during rest periods would sustain compressor performance and mitigate fatigue.

Methods: In Phase I, a volunteer cohort of pre-clinical medical students performed four minutesof continuous compressions on a Resusci-Anne manikin to gauge the spectrum of compressorperformance in the subject population. Compression rate, depth, and chest recoil weremeasured. In Phase II, the highest-performing Phase I subjects were placed into 2-, 3-, and/or4-compressor teams; 2-compressor teams were assigned either to control group (no recoveryexercises) or intervention group (recovery exercises during rest). All Phase II teams participatedin 20-minute simulations with compressor rotation every two minutes. Investigators recordedcompression quality and real-time heart rate data, and calculated caloric expenditure fromcontact heart rate monitor measurements using validated physiologic formulas.

Results: Phase I subjects delivered compressions that were 24.9% (IQR1-3: [0.5%-74.1%])correct with a median rate of 112.0 (IQR1-3: [103.5-124.9]) compressions per minute anddepth of 47.2 (IQR1-3: [35.7-55.2]) mm. In their first rotations , all Phase II subjects deliveredcompressions of similar quality and correctness (p=0.09). Bivariate analyses of 2-, 3-, and4-compressor teams’ subject compression characteristics by subsequent rotation did notidentify significant differences within or across teams. On multivariate analyses, only subjects in2-compressor teams exhibited significantly lower compression rat es (control subjects; p<0.01),diminished chest release (intervention subjects; p=0.03), and greater exertion over successiverotations (both control [p≤0.03] and intervention [p≤0.02] subj ects).

Conclusion: During simulated resuscitations, 2-compressor teams exhibited increased levels ofexertion relative to 3- and 4-compressor teams for comparable compression delivery. Stretchingand breathing exercises intended to assist with compressor recovery exhibited mixed effects oncompression performance and subject exertion.

Introduction: Augmented reality (AR), mixed reality (MR), and virtual reality devices are enabling technologies that may facilitate effective communication in healthcare between those with information and knowledge (clinician/specialist; expert; educator) and those seeking understanding and insight (patient/family; non-expert; learner). Investigators initiated an exploratory program to enable the study of AR/MR use-cases in acute care clinical and instructional settings.

Methods: Academic clinician educators, computer scientists, and diagnostic imaging specialists conducted a proof-of-concept project to 1) implement a core holoimaging pipeline infrastructure and open-access repository at the study institution, and 2) use novel AR/MR techniques on off-the-shelf devices with holoimages generated by the infrastructure to demonstrate their potential role in the instructive communication of complex medical information.

Results: The study team successfully developed a medical holoimaging infrastructure methodology to identify, retrieve, and manipulate real patients’ de-identified computed tomography and magnetic resonance imagesets for rendering, packaging, transfer, and display of modular holoimages onto AR/MR headset devices and connected displays. Holoimages containing key segmentations of cervical and thoracic anatomic structures and pathology were overlaid and registered onto physical task trainers for simulation-based “blind insertion” invasive procedural training. During the session, learners experienced and used task-relevant anatomic holoimages for central venous catheter and tube thoracostomy insertion training with enhanced visual cues and haptic feedback. Direct instructor access into the learner’s AR/MR headset view of the task trainer was achieved for visual-axis interactive instructional guidance.

Conclusion: Investigators implemented a core holoimaging pipeline infrastructure and modular open-access repository to generate and enable access to modular holoimages during exploratory pilot stage applications for invasive procedure training that featured innovative AR/MR techniques on off-the-shelf headset devices.