Distribution of visual attention amongst clinicians using an augmented reality-based decision support system during simulated cardiac arrest - A descriptive study

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• Picked for Emergency Medicine (top studies of the week, 18 October 2026): AR decision support visual attention in simulated cardiac arrest

Abstract

BACKGROUND: Augmented reality (AR)-based cognitive aids provide real-time guidance during resuscitation, but their impact on clinicians' visual attention is not well understood. This study aimed to describe visual attention distribution among clinicians using an AR-based decision support system during simulated pediatric cardiac arrest. METHODS: This descriptive study was a secondary analysis of data from the intervention arm of a randomized clinical trial. Pediatric resuscitation teams from two centers participated in a standardized cardiac arrest simulation. The AR-based decision support system provided role-specific, real-time visual guidance, including task prompts, timers, and medication information displayed within the clinician's field of view. Visual attention data from team leaders and medication nurses were collected using AR devices (HoloLens 2) with built-in eye tracking. Predefined areas of interest (AOIs) were established, and visual attention was quantified using fixation percentage, fixation count, and fixation duration. RESULTS: Nine simulation sessions were analyzed. AR components accounted for a substantial proportion of visual attention (Mean percentage (SD) team leaders: 41.9% (14.9); medication nurses: 59.0% (14.6)). Team leaders demonstrated distributed attention across multiple AOIs, whereas medication nurses showed concentrated attention on medication-related tasks. Distinct fixation patterns were observed, with some AOIs characterized by frequent, brief fixations and others by less frequent, longer fixations. A substantial proportion of attention occurred outside predefined AOIs (team leaders: 46.0% (15.2); medication nurses: 22.9% (10.7)). CONCLUSION: Visual attention during use of the AR-based decision support system by both team leaders and medication nurses was characterized by substantial engagement and distinct role-specific attention patterns.

Clinical trial registration:ClinicalTrials.gov. Identifier: NCT06376643 https://clinicaltrials.gov/study/NCT06376643?cond=cardiac%20arrest&term=siebert&rank=1.

Abstract as published, via PubMed.