Understanding the potential of mixed reality simulation training for the management of ‘can’t intubate–can’t oxygenate’ emergencies

• Published in: BMJ simulation & technology enhanced learning 2020-09, Vol.6 (5), p.310-311
• Main Authors: Sandars, John, Groom, Peter, Brown, Jeremy, Vangorp, Peter, Miller, Tamryn, Miller, Thomas
• Format: Article
• Language: English
• Subjects: Anesthesia; Authenticity; Cameras; Emergencies; Feasibility studies; In Practice Report; Integrated software; Noise; Simulation; Trauma; Virtual reality
• ISSN: 2056-6697; 2056-6697
• DOI: 10.1136/bmjstel-2019-000543

Correspondence to Professor John Sandars, Health Research Institute, Edge Hill University, Ormskirk L39 4QP, UK; [e-mail] Introduction The management of an unanticipated difficult airway resulting in a ‘can’t intubate–can’t oxygenate’ (CICO) emergency is a rare time-critical and life-threatening emergency that is highly stressful, and the associated stress can impair the performance of the whole multidisciplinary team. The fidelity of a simulation is essential for evoking stress during a performance and is determined by (1) the level of immersion, with a sense of presence in which the individual has the perception that they are engaged in a real experience1 and (2) the level of authenticity, which is the extent to which the learner considers the simulation represents a real environment.2 We describe a feasibility study to ensure that the components of an intervention are appropriate to produce the intended outcomes and to identify any changes that may be required for a future larger study. Previous studies suggest that six participants can identify the extent to which the components are appropriate.3 Developing the training simulation We developed a mixed-reality simulation that combined a CICO emergency after induction of anaesthesia within a virtual environment, which was created using high-definition 360° panoramic two-dimensional photographs of real clinical environments. ‘Virtual’ environment Two 360° two-dimensional photographs (an operating theatre’s anaesthetic room and an accident and emergency department’s trauma bay) at Aintree University Hospital were obtained using an Insta360 Pro 8K camera (Insta360, Tustin, California, USA) that was linked via WIFI to an app on an iPhone (Apple, Cupertino, California, USA), which controlled the camera and also made any adjustments, such as resolution.