Each year, 20,000 children in the United States suffer a cardiac arrest, but only 17-50% survive. Survival
is associated with high-quality chest compressions. Yet, healthcare providers adhere to the rate and depth
guidelines recommended by the Pediatric Advanced Life Support (PALS) program for cardiopulmonary
resuscitation (CPR) an abysmal 20-40% of the time. Rates of high-quality chest compressions improve to 64%
with a quality CPR (qCPR) coach (a teammate giving real-time feedback on chest compression performance).
While effective, qCPR coaching is resource and personnel intensive, limiting its use in prehospital or community
settings where most children in cardiac arrest present for care.
A novel strategy to provide real-time CPR feedback without additional personnel is the use of visual
feedback in a medical provider's field of view through augmented reality (AR). An AR feedback system called AR-
CPR has been shown to improve chest compression quality in real time, with promising usability and feasibility.
Data from 34 subjects, demonstrate the feasibility of a head mounted display to offer instantaneous visual CPR
feedback, and improved PALS adherence to chest compression rate and depth goals to 73%, from 17% without
feedback. While these data are promising, significant development and evidence gaps remain.
Therefore, the R21 aims of this proposal are to refine AR-CPR for accurate and precise rate and depth
measurement (R21-Aim 1a), enhance usability (R21-Aim 1b), incorporate recoil feedback (R21-Aim 1c), and
validate the accuracy and precision of all measurements (R21-Aim 2). The R33 aims of this proposal are to
quantitatively evaluate AR-CPR in an international multicenter randomized simulation-based non-inferiority
study as compared to qCPR coaching (R33-Aim 1) and qualitatively evaluate usability and user experience
(R33Aim 2). It is hypothesized that these enhancements will improve the adherence to PALS guidelines and the
rate of high-quality CPR performance, positioning AR-CPR as the most effective pediatric CPR feedback system
available. The proposed research will take place as a multidisciplinary collaboration among investigators at The
Johns Hopkins University School of Medicine, The Johns Hopkins University Applied Physics Laboratory, and
the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE).
In accordance with the mission of The Agency for Healthcare Research and Quality (AHRQ), this
proposal lays the groundwork to refine and improve AR-CPR by making this clinical lifesaving tool easier to
use, accessible, and affordable and thus equitably supporting providers at the point of care to perform higher
quality pediatric CPR in various clinical settings. This research will address two long term key goals: saving
children's lives and addressing inequities in care delivery by making high quality CPR widely available in lower
resource settings including in every hospital and ambulance, and with all automated external defibrillators in
schools, airports, malls, and households.
