Development and usability testing of a fully immersive VR simulation for REBOA training - Birrenbach, T.; Wespi, R.; Hautz, W. E.; Berger, J.; Schwab, P. R.; Papagiannakis, G.; Exadaktylos, A. K.; Sauter, T. C. (Int J Emerg Med, 2023)
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life-saving procedure for bleeding trauma patients. Being a rare and complex procedure performed in extreme situations, repetitive training of REBOA teams is critical. Evidence-based guidelines on how to train REBOA are missing, although simulation-based training has been shown to be effective but can be costly and complex. We aimed to determine the feasibility and acceptance of REBOA training using a fully immersive virtual reality (VR) REBOA simulation, as well as assess the confidence in conducting the REBOA procedure before and after the training. METHODS: Prospective feasibility pilot study of prehospital emergency physicians and paramedics in Bern, Switzerland, from November 2020 until March 2021. Baseline characteristics of trainees, prior training and experience in REBOA and with VR, variables of media use (usability: system usability scale, immersion/presence: Slater-Usoh-Steed, workload: NASA-TLX, user satisfaction: USEQ) as well as confidence prior and after VR training were accessed. RESULTS: REBOA training in VR was found to be feasible without relevant VR-specific side-effects. Usability (SUS median 77.5, IQR 71.3-85) and sense of presence and immersion (Slater-Usoh-Steed median 4.8, IQR 3.8-5.5) were good, the workload without under-nor overstraining (NASA-TLX median 39, IQR 32.8-50.2) and user satisfaction high (USEQ median 26, IQR 23-29). Confidence of trainees in conducting REBOA increased significantly after training (p < 0.001). CONCLUSIONS: Procedural training of the REBOA procedure in immersive virtual reality is possible with a good acceptance and high usability. REBOA VR training can be an important part of a training curriculum, with the virtual reality-specific advantages of a time- and instructor-independent learning.
Keywords: journalArticle; Medical education; Reboa; Science foundation, Zoll foundation, Drager Medical Germany, Mundipharma Research; Trauma resuscitation; UK, MDI International Australia, Roche Diagnostics Germany, all outside the; UK, Mundipharma Medical Switzerland, VisualDx USA, all outside the submitted; University of Bern sponsored by the Touring Club Switzerland. The sponsor has no; Virtual reality; and MDI International Australia, all outside the submitted work. WEH has received; financial support for a congress he chaired from EBSCO Germany, Isabel Healthcare; influence on the research or decision to publish. GP is co-founder, CEO and CTO; of ORamaVR. The company had no influence on the study setup and interpretation of; submitted work. WEH has provided paid consultancies to AO foundation Switzerland; the results or decision to publish. All other authors have nothing to disclose; work. TCS holds the endowed professorship of emergency telemedicine at the