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TECHNOLOGY, COMPUTING, AND SIMULATION

A Simulation-Based Evaluation of a Graphic Cardiovascular Display

Robert W. Albert, MA^*, James A. Agutter, MArch^*, Noah D. Syroid, MS^*, Ken B. Johnson, MD, Robert G. Loeb, MD, and Dwayne R. Westenskow, PhD^*

From the *Applied Medical Visualizations LLC; Departments of Architecture and Anesthesiology, University of Utah, Salt Lake City, Utah; and Department of Anesthesiology, University of Arizona, Tucson, Arizona.

Address correspondence and reprint requests to Robert Albert, MA, Applied Medical Visualizations, LLC, 925 East 900 South, Salt Lake City, UT 84105. Address e-mail to ralbert{at}medvis.com.

INTRODUCTION: A graphic presentation of complex information can facilitate early detection and management of adverse events. Prior work found that graphical presentation of selected cardiovascular variables led to earlier detection of a simulated ischemic event. Based on these findings, a second evaluation explored the utility of a graphical cardiovascular display (GCD) in a variety of simulated adverse cardiopulmonary events for two different display configurations. In this evaluation, we revised the GCD to present hemodynamic variables with or without a pulmonary artery catheter. Our hypotheses were that the revised GCD would improve detection of adverse cardiopulmonary events and add no additional perceived workload.

METHODS: Sixteen anesthesiologists and anesthesia residents were enrolled in a simulation-based evaluation of the GCD. Participants were randomly split into two groups balanced for expertise and asked to manage six simulated adverse cardiopulmonary events. The GCD was present in half of the simulations, balanced across scenarios and groups. Participants’ verbalizations and actions during each scenario were recorded and transcribed. Transcripts of treatment interventions were subsequently rated by two blinded expert anesthesiologists. Perceived workload, time to detection, and proper treatment of the adverse event were compared between groups.

RESULTS: Experts ranked anesthesiologists using the GCD as being more effective overall and individually in three of six scenarios. Use of the GCD was demonstrated to influence the time to detection and the time to treatment of some critical events. There were no workload differences between display groups.

DISCUSSION: Treatment intervention by participants using the GCD was rated superior by two blinded experts. The presence of the GCD resulted in a modest improvement in the time to detect myocardial ischemia and increased pulmonary capillary wedge pressure. The GCD may be a useful adjunct to monitor patients during adverse cardiopulmonary events.

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