Table 2 Systematic review of augmented reality in intensive care medicine

Dias et al

(2021, USA) *

[68]

15/15/15

Randomized controlled study

2

ICU nurses (neonatal)

n/a

Endotracheal intubation of a puppet

Training

AR-assisted video laryngoscopy (AVL) with a magnified video of the airway into the intubator’s visual field

Direct laryngoscopy (DL) or indirect video laryngoscopy (IVL)

The DL group successfully intubated on 32% of attempts compared to 72% in the IVL group and 71% in the ARVL group (P < 0.001). The DL group intubated the esophagus on 27% of attempts, whereas there were no esophageal intubations in either the IVL or ARVL groups (P < 0.001). The median (interquartile range) time to intubate in the DL group was 35.6 (22.9–58.0) seconds, compared to 21.6 (13.9–31.9) seconds in the IVL group and 20.7 (13.2–36.5) seconds in the ARVL group (P < 0.001)

Huang et al. (2018, USA) *

[60]

16/16

Randomized controlled study

2

ICU clinicians and trainees

29.8 ± 7.8

Central venous catheters in the manikin

Training

The AR simulation group had a 5–10-min hands-on instructional course to allow familiarity with the AR equipment. During central line placement, a video was displayed repeating essential steps

Using the ultrasound to attempt an internal jugular vein central line insertion on a manikin

No difference regarding the meantime for placement or procedure time, but a significantly higher adherence level between the two groups favoring the AR group (p = 0.003)

Heo et al. (2022, Republic of Korea) *

[64]

15/15

Randomized controlled study

2

Nurses

24—53

AR-based self-learning

A platform for novices to set up a ventilator without on-site assistance

Training

The AR group was guided by AR-based instructions and requested assistance with the head-mounted display

The manual group used a printed manual and made a phone call for assistance

Fewer participants requested assistance in the AR group compared to the manual group and the number of steps that required assistance was lower in the AR group. A higher rating in predeveloped questions for confidence and suitability of the method

Alismail et al. (2019, USA) *

[63]

15/17

Controlled study

3

ICU clinicians and trainees

30 ± 7.8

Endotracheal intubation of a puppet

Training

Intubation of a puppet with AR glasses head mount display that displayed the essential steps

Intubation (of a puppet)

The AR group took longer median (min, max) time (seconds) to ventilate than the non-AR group (280 (130,740) vs 205 (100,390); η 2 = 1.0, p = 0.005, respectively). Similarly, there was a higher percent adherence to the NEJM intubation checklist (100% in the AR group vs 82.4% in the non-AR group; η2 = 1.8, p < 0.001)

Fumagalli et al. (2017,

Italy) *

[61]

56/47

Controlled study

3

ICU personnel

74 ± 12

AR-assisted venous puncture using near-infrared electromagnetic radiation in elderly ICU patients

Admission to ICU

Venous puncture with AR

Standard venous puncture

The use of the novel NIR-based device is safer and more psychologically tolerable (p = 0,038), and it is not associated with an increase in procedure length (standard: 7.0 ± 3.9 vs. AR: 8.0 ± 5.8 min, p = 0.173) or several attempts (standard: 1.3 ± 0.6 vs. NIR-BD: 1.2 ± 0.6, p = 0.361). Hematoma development after venipuncture was directly associated with a significant reduction in AR group patients (OR 0.21, 95% CI 0.05–0.80, p = 0.022)

Bloom et al. (2022, USA)

[85]

30/0

Observational study

3

Pediatric cardiologists or intensivists

n/a

Venous puncture

Training

Venous puncture with mixed reality

Conventional US

Reduction in the number of needles repositions (P = 0.03), improvement in quality of access as measured by distance (P < 0.0001) and angle of elevation (P = 0.006), faster time to access (P = 0.04), fewer number of both access attempts (P = 0.02) and a number of needles repositions (P < 0.0001) compared to conventional US. Postparticipant surveys showed high levels of usability (87%) and a belief that MantUS may decrease adverse outcomes (73%) and failed access attempts (83%)

Zackoff et al. (2021, USA) *

[66]

84/0

Observational study

3

ICU clinicians and trainees

n/a

Assessing a decompensating patient in a training situation

n/a

All teams completed two pieces of training: (1) traditional training using a manikin and (2) AR-enhanced training using a manikin plus an AR patient

n/a

AR improved the ability to assess the patient's mental status, respiratory status, and perfusion status (all P < 0.0001) during AR in comparison to TT. Similar findings were noted for the recognition of hypoxemia, shock, apnea, and decompensation (all P ≤ 0.0003) but not for the recognition of cardiac arrest (P = 0.06)

Yamada et al. (2019,

Japan) *

[67]

n/a

Observational study

3

Perfusionist

n/a

AR experiences using the back camera of a smartphone or tablet. We can also build our instrument with custom visualization and data analysis

n/a

AR program for Extracorporeal circulation technology

n/a

Results indicate that future perfusionists may study AR in classrooms because there is an intimate relationship between virtual and physical objects. This AR technology for ECC is cost-effective and relatively easy to construct

Scquizzato (2020, Italy) *

[69]

n/a

Observational study

3

ICU or emergency personnel

n/a

A smartphone application with augmented reality for estimating weight in critically ill pediatric patients

n/a

A smartphone app that estimates child weight using the smartphone camera and augmented reality (AR) by implementing a virtual 3D tape

n/a

This app could improve a child’s weight estimation by implementing and training a machine learning regression model that features measurement data from the app, child gender, and habitus

Morillas Perez et al. (2023, Spain) *

[62]

6/0

Cohort study

3

ICU personnel

n/a

AR-assisted vascular puncture

Training

Simulation of an AR-assisted vascular puncture on an experimental model

n/a

37 with 33 punctures were successful and after technical improvements, 39 with 38. There are no significant differences between the operators and between the ultrasound scanners. AR-based punctures provide greater accuracy, and greater comfort by freeing the hands and keeping the gaze on the working field

Gan et al

(2019, USA) *

[65]

6

Case series

4

ICU personnel

n/a

AR-assisted percutaneous dilatational tracheostomy

Tracheostomy

Augmented reality during percutaneous dilatational tracheostomy placement

n/a

“Good success and excellent user feedback”