Munich: Nursing staff are trained with virtual reality glasses – Munich

These glasses have no lenses. And looks more like bulky diving goggles – but without a viewing window. With these virtual reality glasses (VR glasses) you don’t look outside, but into virtual rooms. For example, in room six in the intensive care unit of the clinic for congenital heart defects and pediatric cardiology at the German Heart Center in Munich (DHM).

Software developers, working very closely with doctors and nurses at the Technical University’s Heart Center, “modeled” the room for a training program one-to-one with centimeter precision. In the middle of the room lies a digital infant on the intensive care bed. In addition to many flashing monitors. On many hoses. At the extracorporeal membrane oxygenation, the Ecmo.

Ecmo – four letters. They stand for a highly invasive therapy method that has come into public focus, especially since Corona. Because many patients with a severe Covid 19 infection – around a quarter of these patients – are treated with an Ecmo. However, it is also used for other serious illnesses. When a patient can no longer independently manage gas exchange via the heart-lung system. When the heart can no longer keep up the circulation.

The device works like an artificial lung and takes over the respiratory function performance. Depending on the cannulation, a centrifugal pump can take over the function of the heart. Two cannulas are inserted into a large vein and/or artery. One leads, as senior physician Bettina Ruf explains, “low-oxygen blood” out of the body. In the so-called oxygenator, i.e. the artificial lung, it is then enriched with oxygen again and “returned to the patient via the other cannula,” says the 51-year-old, who has been working at the heart center for 17 years.

The view through the glasses sends the user into virtual reality. To a child in dire need of help that needs to be hooked up to the Ecmo. This is exactly what should now happen in a virtual way. Monitors, bed, ecmo – everything is housed in a very small space. You’re almost afraid of knocking something over. The inside of the open left hand becomes the display. The real right hand suddenly turns magically blue and the digital index finger presses the start button. A voice explains the Ecmo function and says what has to be done now: insert the catheter.

Andrea Engelhardt, 50, gave her godchild the idea of ​​using VR glasses before Corona and using them for a program that trains nurses and doctors to work with Ecmo. In February 2022, together with her colleague Anne Stiller, 43, she begins to put the idea into practice. They apply for funding, look for software developers, get doctors and nurses on board. Right from the start, it was important to the head of the study center to work together and to get people enthusiastic about the project. Until then, they had practiced on simulation dummies, but “such a training program,” as she says, simply didn’t exist yet.

Ecmo requires intensive care

The Ecmo means hope in a life-threatening situation. But it is often the last therapeutic option. And it also scares people: so many hoses, so many devices and an immensely high level of care and support. A patient has to be cared for around the clock. The intensive care staff also have respect for the Ecmo, explains Heike Flick, head of the intensive care unit 3.3 of the clinic for congenital heart defects and pediatric cardiology. Despite high professionalism in dealing with these patients. Because every movement has to be perfect when the heart-lung machine has to be connected quickly. “Faults in the Ecmo are not easy to fix. This is a very special area in intensive care,” she says, and that’s why it’s very good that with this “unique” exercise program on Lazarettstrasse, the nursing staff “are able to overcome their fears of contact the Ecmo” could take.

The blue hand grabs the catheter. It can be used directly over the chest of newly operated infants. If everything goes well, continue. With additional notes, explanations. Every action is documented. For later, for analysis. “Getting into a routine, training for emergency scenarios,” believes Bettina Ruf, is very important. Especially in a “protected environment,” adds Engelhardt. In an emergency situation, the Ecmo must run immediately, no air must get into the hoses, the blood must not clot in the hoses, all connections must be tight – “everything does not work without the nurse, without a doctor,” says the senior doctor.

Every little detail is worked into the program

A pin board with yellow notes. Countless photos, scripts, descriptions. Every step was recorded for the development of the program, says Daniela Böhrer from the UP design studio. One was in the intensive care room umpteen times, the machine was studied umpteen times. “We discussed every move, every little detail with the doctors and nurses, and considered what the most important criteria for Ecmo training software are,” explains the 29-year-old product designer. Reality was transferred to the digital world.

Doctors and nurses at the heart center have always been trained in regular Ecmo workshops – but now with VR glasses and the virtual Ecmo. The initial skepticism about the glasses and the program has disappeared. “When I put on the glasses for the first time,” says Bettina Ruf, “I was very impressed by how lifelike everything is”. Now the program is to become a “marketable product,” says Engelhardt. Because other clinics have already shown interest.

Around 20 patients a year are placed on the Ecmo in the clinic for congenital heart defects and pediatric cardiology, 500 heart operations are carried out on the heart-lung machine and around 800 treatments are carried out in the cardiac catheter laboratory. Patients often have to go to Ecmo afterwards. Peter Ewert, Head of the Department of Pediatric Cardiology at the DHM, assumes that the program will prove its worth. Because it will be “a blueprint for training many other complex and expensive intensive care procedures”.