More than 20,000 children experience a cardiac arrest each year in the U.S., according to published literature. Sadly, most do not survive. That inspired Justin Jeffers, MD (MEHP ’19), to develop an augmented reality tool to improve people’s ability to perform CPR. He recently was awarded a five-year, $1 million grant from the Agency for Healthcare Research and Quality (AHRQ) for the project.
“The only thing shown to improve survival is high-quality CPR, and even knowing that, we only meet CPR guidelines for proper technique 20–40% of the time,” says Jeffers, an assistant professor of pediatrics at Johns Hopkins whose expertise is pediatric emergency medicine. Existing devices to provide CPR feedback are imperfect, he says, with some offering information on just one part of CPR, like how deep or how fast someone is performing compressions.
Jeffers, working with Keith Kleinman, MD, director of pediatric emergency technology at Johns Hopkins, and a team of engineers from the Johns Hopkins University Applied Physics Laboratory, designed and tested an augmented reality (AR) CPR feedback system. The system consists of a sensor device placed on a mannequin’s chest that measures the depth and speed of chest compressions and then relays that information to a head-mounted visual display worn by the person performing compressions. A display on the glasses guides the person toward optimal technique through simple responses like “good” or “go slower.”
In a pilot study, the team had a group of 34 health care workers including nurses, attending physicians, and medical and physician assistant students and residents test the system while performing chest compressions on a mannequin to represent a 5-year-old child. They first performed compressions as usual and then were randomized to use the AR system in either a second or third round of compressions. Chest compression performance improved from 17% to 73% using the feedback tool, even with no formal instruction on how to use it. Results were published last summer in the journal Resuscitation Plus.
The first two years of the AHRQ grant will be spent further developing the system, Jeffers says. During the last three years, the team will conduct a multicenter simulation trial using mannequins and compare learning outcomes to the gold standard of care, which uses a human-quality CPR coach. While such coaches can significantly improve CPR guideline adherence, using one is very resource-intensive, and almost all non-academic medical centers don’t have these professionals available, he says.
“The pie-in-the-sky goal is that this gets developed to a point where it can be FDA [Food and Drug Administration]-tested and approved for clinical use,” Jeffers says. “We think that this is going to save lives.” Once approved, it could be attached to automated external defibrillators housed at airports, shopping malls, gyms, and other locations, he says, where ideally “any lay person can just put on this headset and be told how to do better CPR.”