170 - Comparison of Team Performance and Cognitive Load in Mixed-Reality HoloBaby™ versus High-Fidelity Simulation Technology During Neonatal Resuscitation Training

Publication Number: 4167.170

Tara Palnitkar, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Leah Marie Seften, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, CT, United States; Leah Mallory, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Misty Melendi, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Gavin Blair, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Tania D. Strout, Maine Medical Center, Portland, ME, United States; Anya Cutler, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Dani Bruno, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Tyler Johnson, The Barbara Bush Children's Hospital at Maine Medical Center, Saco, ME, United States; Michael Ferguson, Maine Medical Center, Portland, ME, United States; Allison Zanno, The Barbara Bush Children's Hospital at Maine Medical Center, Falmouth, ME, United States

Background: Simulation has been shown to be an effective tool to prepare clinical teams for neonatal resuscitations, which are high-acuity, low-occurrence events. Mixed-reality (MR) simulation, a developing technology, offers a lower-cost option, compared to traditional high-fidelity (HiFi) simulation, while still providing realistic visuals. Our team, in partnership with Interactive Commons at Case Western Reserve University, developed HoloBaby™, a MR neonatal hologram prototype.

Objective: In this work, we conducted a pilot crossover study comparing team adherence to Neonatal Resuscitation Program (NRP®) guidelines during simulations and cognitive load between HoloBaby™ and HiFi simulator technologies.

Design/Methods: We conducted 6 simulation sessions; each session consisted of two simulation scenarios with each technology, with technology order randomized per session. Interprofessional teams of 3-4 neonatal clinicians participated in each session. After each technology, participants completed the NASA Task Load survey. Video recordings of the second scenario (a full-code simulation) for each technology were scored by neonatologists for adherence to NRP®. We tested for non-inferiority of HoloBaby™ to HiFi using linear mixed effects regression models with NRP® score as the outcome, fixed effects for technology and order of training, and a random effect for team. Non-inferiority was determined by 95% confidence intervals not exceeding -5%, 5%. We tested the association between technology and NASA Task Load results using paired Wilcoxon Rank Sum tests.

Results: Non-inferiority was found for cumulative NRP® score as well as for the following subcategory scores: heart rate check, intubation, and medication. It was not found for the subcategory scores: group function, preparation/equipment check, oxygen use, positive pressure ventilation, and cardiac compression. NASA Task Load scores differed significantly between the two technologies in three areas: mental demand, performance, and frustration, with participants reporting higher mental demand, lower performance, and higher frustration with HoloBaby™ vs HiFi.

Conclusion(s): HoloBaby™ can be used by NICU teams during neonatal resuscitation simulations without reducing overall NRP® adherence relative to HiFi. While HoloBaby™ presented increased mental demand and frustration and lower perceived performance among participants, actual NRP® score did not differ. Additional strategies to mitigate these increased mental demands must be explored. Further work is necessary to evaluate the efficacy of MR in clinical teams with less routine resuscitation or simulation experience.

Team NRP® Percent Score for HiFi and HoloBaby™
Teams performed a simulation with HiFi and a simulation with HoloBaby™, each of which was scored by a neonatologist for adherence to NRP®. Their percent NRP® scores for HiFi appear on the left and scores for HoloBaby™ on the right. Technology order is shown by line color (HiFi first in red, HoloBaby™ first in blue), with a slight dodge effect applied to visualize overlapping scores where possible.

NRP® Score and Beta Estimates
Linear mixed effects models were used to determine if there was a difference in NRP® score between the HiFi condition and HoloBaby™ condition. A covariate was included to account for the order of technologies (HiFi first vs. HoloBaby™ first), and a random effect was included for team to account for the paired data. If the 95% CI is within (-5%, 5%), then we can conclude non-inferiority of HoloBaby™ to HiFi.

NASA Task Load for HiFi and HoloBaby™
Participant completed NASA Task Load surveys for both HiFi and HoloBaby™. Paired Wilcox Rank tests were used to compare survey results of the two technologies.