253 AIRWAY-XR: Augmented Instruction to Refine Wayfinding and Yielding Skills in Emergency Medicine Residents for Intubation Using Mixed Reality Technology

The ability to maintain a patient airway is critical in emergency situations. Training in intubation and airway management is essential for Emergency Medicine (EM). Traditional approaches to airway education include textbooks, didactics, assisted practice on airway trainers, and direct patient contact. Mixed reality (MR) technology provides an opportunity to enhance the learning experience by allowing an immersive, interactive, and engaging training environment. The objective of this study is to establish the feasibility of an MR airway education module that we plan to compare to a more traditional airway teaching in a later non-inferiority trial. We collected preliminary data at the Protected Airway Collaborative (PAC). PAC is an advanced airway course that uses an innovative learning delivery system to bridge the digital/physical divide to deliver complex concepts, skills, and procedure training. Users were asked to operate the Microsoft HoloLens 2, a HIPAA compliant MR device, capable of audio and video communication and 2D/3D digital content placement onto the real world. Users were coached to intubate mannikins complete with upper airway anatomy and two inflatable lungs with an esophagus connected to an inflatable balloon mimicking the stomach. During intubation, the user’s field of view (FOV) was annotated with images and highlights identifying key structures while observing how the user intubated. Microsoft Teams was utilized as the platform for video sharing during sessions. We utilized pre- and post-test surveys to assess prior experience with the technology and the overall user experience. During PAC, we collected pre- and post-survey data from our users including Emergency Medicine Attendings, Residents, APP (Advanced Practice Provider) Residents. 12 users filled in a pre-survey survey, and 9 users completed a post-survey. When asked to rate their computer skills on scale of ”Poor” – “Excellent,” 8 % said “Fair,” 17% said “Good,” 58% stated “Very Good,” and 17 % stated “Excellent.” When asked about prior experience with AR/VR/MR prior to the session, 58% said “Yes,” while 42% said “No”. On the post-survey, when asked to rate their overall experience from on a scale of “Poor” – “Excellent”, 33% said, “Very Good,” while 67% said “Excellent.” When asked “How easy was it to get comfortable with the HoloLens as a coaching tool?” on a scale of “Very Easy” – “Very Hard,” 11% said “Normal,” 22% said “Easy” while 67% said “Very Easy.” The study at this time is limited given the small census and exclusively testing group A. We understand this is a preliminary dataset but from the positive engagement from learners at PAC, future enrollment will include a clinical trial of MR as an educational and telemedicine tool. We plan to enroll 21 of our new EM interns into two groups, group A with HoloLens 2, and group B with current traditional didactics. We will have two aims in mind: 1) assessment of a telemedicine remote training scenario with a PAC instructor coaching an EM intern remotely and 2) assessment of effective intubation with complex airway scenarios and simulations when using MR. If HoloLens is non-inferior to traditional didactics, this presents us with a unique opportunity to establish an innovative class for intubations with scalable, reproducible, and easily deployed technology, and without limitations of current methodologies regarding staffing, location, timing or availability.