Analysis of neonatal resuscitation using eye tracking: a pilot study

BackgroundVisual attention (VA) is important for situation awareness and decision-making. Eye tracking can be used to analyse the VA of healthcare providers. No study has examined eye tracking during neonatal resuscitation.ObjectiveTo test the use of eye tracking to examine VA during neonatal resuscitation.MethodsSix video recordings were obtained using eye tracking glasses worn by resuscitators during the first 5 min of neonatal resuscitation. Videos were analysed to obtain (i) areas of interest (AOIs), (ii) time spent on each AOI and (iii) frequency of saccades between AOIs.ResultsFive videos were of acceptable quality and analysed. Only 35% of VA was directed at the infant, with 33% at patient monitors and gauges. There were frequent saccades (0.45/s) and most involved patient monitors.ConclusionDuring neonatal resuscitation, VA is often directed away from the infant towards patient monitors. Eye tracking can be used to analyse human performance during neonatal resuscitation.

Download Full-text

Effect of monitor positioning on visual attention and situation awareness during neonatal resuscitation: a randomised simulation study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-316992 ◽

2019 ◽

Vol 105 (3) ◽

pp. 285-291

Author(s):

Brenda Hiu Yan Law ◽

Po-Yin Cheung ◽

Sylvia van Os ◽

Caroline Fray ◽

Georg M Schmölzer

Keyword(s):

Visual Attention ◽

Eye Tracking ◽

Situation Awareness ◽

Simulation Study ◽

Assessment Tool ◽

Healthcare Providers ◽

Neonatal Resuscitation ◽

Protocol Adherence ◽

Randomised Controlled ◽

Radiant Warmer

ObjectivesTo compare situation awareness (SA), visual attention (VA) and protocol adherence in simulated neonatal resuscitations using two different monitor positions.DesignRandomised controlled simulation study.SettingsSimulation lab at the Royal Alexandra Hospital, Edmonton, Canada.ParticipantsHealthcare providers (HCPs) with Neonatal Resuscitation Program (NRP) certification within the last 2 years and trained in neonatal endotracheal intubations.InterventionHCPs were randomised to either central (eye-level on the radiant warmer) or peripheral (above eye-level, wall-mounted) monitor positions. Each led a complex resuscitation with a high-fidelity mannequin and a standardised assistant. To measure SA, situation awareness global assessment tool (SAGAT) was used, where simulations were paused at three predetermined points, with five questions asked each pause. Videos were analysed for SAGAT and adherence to a NRP checklist. Eye-tracking glasses recorded participants’ VA.Main outcome measureThe main outcome was SA as measured by composite SAGAT score. Secondary outcomes included VA and adherence to NRP checklist.ResultsThirty simulations were performed; 29 were completed per protocol and analysed. Twenty-two eye-tracking recordings were of sufficient quality and analysed. Median composite SAGAT was 11.5/15 central versus 11/15 peripheral, p=0.56. Checklist scores 46/50 central versus 46/50 peripheral, p=0.75. Most VA was directed at the mannequin (30.6% central vs 34.1% peripheral, p=0.76), and the monitor (28.7% central vs 20.5% peripheral, p=0.06).ConclusionsSimulation, SAGAT and eye-tracking can be used to evaluate human factors of neonatal resuscitation. During simulated neonatal resuscitation, monitor position did not affect SA, VA or protocol adherence.

Download Full-text

An Exploratory Application of Eye-Tracking Methods in a Discrete Choice Experiment

Medical Decision Making ◽

10.1177/0272989x18782197 ◽

2018 ◽

Vol 38 (6) ◽

pp. 658-672 ◽

Cited By ~ 3

Author(s):

Caroline Vass ◽

Dan Rigby ◽

Kelly Tate ◽

Andrew Stewart ◽

Katherine Payne

Keyword(s):

Decision Making ◽

Eye Tracking ◽

Risk Communication ◽

Discrete Choice ◽

Dwell Time ◽

Ordinary Least Squares ◽

Discrete Choice Experiments ◽

Tracking Data ◽

Significant Difference ◽

Areas Of Interest

Background. Discrete choice experiments (DCEs) are increasingly used to elicit preferences for benefit-risk tradeoffs. The primary aim of this study was to explore how eye-tracking methods can be used to understand DCE respondents’ decision-making strategies. A secondary aim was to explore if the presentation and communication of risk affected respondents’ choices. Method. Two versions of a DCE were designed to understand the preferences of female members of the public for breast screening that varied in how risk attributes were presented. Risk was communicated as either 1) percentages or 2) icon arrays and percentages. Eye-tracking equipment recorded eye movements 1000 times a second. A debriefing survey collected sociodemographics and self-reported attribute nonattendance (ANA) data. A heteroskedastic conditional logit model analyzed DCE data. Eye-tracking data on pupil size, direction of motion, and total visual attention (dwell time) to predefined areas of interest were analyzed using ordinary least squares regressions. Results. Forty women completed the DCE with eye-tracking. There was no statistically significant difference in attention (fixations) to attributes between the risk communication formats. Respondents completing either version of the DCE with the alternatives presented in columns made more horizontal (left-right) saccades than vertical (up-down). Eye-tracking data confirmed self-reported ANA to the risk attributes with a 40% reduction in mean dwell time to the “probability of detecting a cancer” ( P = 0.001) and a 25% reduction to the “risk of unnecessary follow-up” ( P = 0.008). Conclusion. This study is one of the first to show how eye-tracking can be used to understand responses to a health care DCE and highlighted the potential impact of risk communication on respondents’ decision-making strategies. The results suggested self-reported ANA to cost attributes may not be reliable.

Download Full-text

Simulation-based training of critical events during cardiopulmonary bypass: importance of a critical events checklist

Perfusion ◽

10.1177/0267659120937125 ◽

2020 ◽

pp. 026765912093712

Author(s):

Frank Merkle ◽

Dino Kurtovic ◽

Andreas Matschke ◽

Benjamin Haupt ◽

Volkmar Falk ◽

...

Keyword(s):

Decision Making ◽

Heart Rate ◽

Heart Rate Variability ◽

Cardiopulmonary Bypass ◽

Eye Tracking ◽

Critical Event ◽

Correct Decision ◽

Critical Events ◽

Educational Approach ◽

Areas Of Interest

Objectives: Evaluation of critical events training for clinical perfusionists is necessary to improve this educational approach. Critical events checklists are effective in reducing clinical complications, but should be tested in a simulation environment first. Individual behavior and stress response of clinical perfusionists during simulated critical events on cardiopulmonary bypass have not been evaluated yet. This study focuses on the evaluation of critical events training and critical events checklists in simulated cardiopulmonary bypass. Methods: A total of 19 clinical perfusionists from a single hospital took part in two simulated critical event scenarios. Clinical perfusionist behavior and physiological responses were recorded using eye tracking, heart rate variability, video, and audio. In addition, workloads were determined and participants were interviewed. Results: Relevant areas of interest were identified for each simulation phase. During critical event detection and subsequent decision-making, areas of interest hits and fixation durations varied with the use of a critical events checklist. Times to decision were shorter, decision quality was higher, and temporal workload was increased when the checklist was used. Evaluation of selected heart rate variability measures revealed a good correlation with pupil diameters. Conclusion: Evaluation of critical events during simulated cardiopulmonary bypass shows that the scenario is realistic and relevant for clinical practice. Integrating a critical events checklist improves the probability of correct decision-making and shortens the correct decision time. Temporal workload is increased when using a checklist. Eye tracking and heart rate variability are well suited to evaluate participants’ behaviors and stress levels. All participants welcomed simulation training for critical incidents.

Download Full-text

Video-based reflection on neonatal interventions during COVID-19 using eye-tracking glasses: an observational study

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-321806 ◽

2021 ◽

pp. fetalneonatal-2021-321806

Author(s):

Michael Wagner ◽

Maria C den Boer ◽

Sophie Jansen ◽

Peter Groepel ◽

Remco Visser ◽

...

Keyword(s):

Eye Tracking ◽

Neonatal Intensive Care ◽

Primary Outcome ◽

Medical Center ◽

Healthcare Providers ◽

Point Of View ◽

Bedside Teaching ◽

Additional Tool ◽

Video Recordings ◽

Single Centre Study

ObjectiveThe aim of this study was to determine the experience with, and the feasibility of, point-of-view video recordings using eye-tracking glasses for training and reviewing neonatal interventions during the COVID-19 pandemic.DesignObservational prospective single-centre study.SettingNeonatal intensive care unit at the Leiden University Medical Center.ParticipantsAll local neonatal healthcare providers.InterventionThere were two groups of participants: proceduralists, who wore eye-tracking glasses during procedures, and observers who later watched the procedures as part of a video-based reflection.Main outcome measuresThe primary outcome was the feasibility of, and the proceduralists and observers’ experience with, the point-of-view eye-tracking videos as an additional tool for bedside teaching and video-based reflection.ResultsWe conducted 12 point-of-view recordings on 10 different patients (median gestational age of 30.9±3.5 weeks and weight of 1764 g) undergoing neonatal intubation (n=5), minimally invasive surfactant therapy (n=5) and umbilical line insertion (n=2). We conducted nine video-based observations with a total of 88 observers. The use of point-of-view recordings was perceived as feasible. Observers further reported the point-of-view recordings to be an educational benefit for them and a potentially instructional tool during COVID-19.ConclusionWe proved the practicability of eye-tracking glasses for point-of-view recordings of neonatal procedures and videos for observation, educational sessions and logistics considerations, especially with the COVID-19 pandemic distancing measures reducing bedside teaching opportunities.

Download Full-text

Effect of Monitor Placement on Situational Awareness and Visual Attention in Simulated Neonatal Resuscitations

Paediatrics & Child Health ◽

10.1093/pch/pxy054.074 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e28-e29

Author(s):

Brenda Hiu Yan Law ◽

Po-Yin Cheung ◽

Sylvia van Os ◽

Caroline Fray ◽

Georg Schmölzer

Keyword(s):

Visual Attention ◽

Eye Tracking ◽

Situation Awareness ◽

Neonatal Intensive Care ◽

Situational Awareness ◽

Assessment Tool ◽

Vital Signs ◽

Neonatal Resuscitation ◽

User Preference ◽

And Performance

Abstract BACKGROUND Decision-making in neonatal resuscitation depends on clinical evaluation, oxygen saturation and heart-rate. However, the position of vital signs monitors varies between institutions and might lead to obstructed or difficult to see displays, which might affect Health Care Provider (HCP) performance. OBJECTIVES To compare Situation Awareness (SA), Neonatal Resuscitation (NRP) checklist score, Visual Attention (VA) and participant satisfaction during simulated neonatal resuscitations using two vital signs monitors locations. DESIGN/METHODS NRP-trained HCPs were recruited from a tertiary Neonatal Intensive Care Unit and randomized to either central (eye-level on the radiant warmer) or peripheral (left of the warmer) monitor placement. Following an orientation scenario, each HCP lead a resuscitation requiring intubation and chest compressions with a high-fidelity manikin (Newborn HAL, Gaumard Scientific, Miami, FL) and a standardized assistant. Each scenario was paused at 3 predetermined points and the HCP was asked 5 SA questions at each pause, per the Situation Awareness Global Assessment Tool (SAGAT) format. Simulations were video-recorded to analyze SAGAT responses and performance rating using a modified NRP checklist. VA was recorded using eye-tracking glasses (Tobii Pro, Tobii Technology Inc., Falls Church, VA) worn by participants. Statistical analysis was performed using Mann-Whitney U test. A post-simulation survey examined user preference. RESULTS We randomized 30 HCPs; all were analyzed for SA and NRP checklist scores. Twenty-two eye-tracking recordings were of sufficient quality and analyzed. SAGAT scores (median 11/15 vs. 12/15, p=0.52) and NRP Checklist Scores (median 46/50, p=0.75) were similar between groups. Distribution of VA was also similar in both groups. In the post-simulation survey, all HCPs found central monitor placement convenient, compared with only 8/15 in peripheral placement. CONCLUSION During simulated neonatal resuscitation, HCPs found central monitor placement more convenient. However, no differences in accuracy of situation awareness responses, NRP checklist scores, or visual attention were found. Hi-fidelity simulation, SAGAT, and eye-tracking can be used to evaluate physical ergonomics of neonatal resuscitation.

Download Full-text

Correlation Evaluation of Pilots’ Situation Awareness in Bridge Simulations via Eye-Tracking Technology

Computational Intelligence and Neuroscience ◽

10.1155/2021/7122437 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Shaoqi Jiang ◽

Weijiong Chen ◽

Yutao Kang

Keyword(s):

Standard Deviation ◽

Eye Tracking ◽

Situation Awareness ◽

Fixation Duration ◽

Heat Maps ◽

Attentional Resources ◽

Scan Paths ◽

Areas Of Interest ◽

Tracking Technology ◽

Saccade Duration

To maintain situation awareness (SA) when exposed to emergencies during pilotage, a pilot needs to selectively allocate attentional resources to perceive critical status information about ships and environments. Although it is important to continuously monitor a pilot’s SA, its relationship with attention is still not fully understood in ship pilotage. This study performs bridge simulation experiments that include vessel departure, navigation in the fairway, encounters, poor visibility, and anchoring scenes with 13 pilots (mean = 11.3 and standard deviation = 1.4 of experience). Individuals were divided into two SA group levels based on the Situation Awareness Rating Technology (SART-2) score (mean = 20.13 and standard deviation = 5.83) after the experiments. The visual patterns using different SA groups were examined using heat maps and scan paths based on pilots’ fixations and saccade data. The preliminary visual analyses of the heat maps and scan paths indicate that the pilots’ attentional distribution is modulated by the SA level. That is, the most concerning areas of interest (AOIs) for pilots in the high and low SA groups are outside the window (AOI-2) and electronic charts (AOI-1), respectively. Subsequently, permutation simulations were utilized to identify statistical differences between the pilots’ eye-tracking metrics and SA. The results of the statistical analyses show that the fixation and saccade metrics are affected by the SA level in different AOIs across the five scenes, which confirms the findings of previous studies. In encounter scenes, the pilots’ SA level is correlated with the fixation and saccade metrics: fixation count ( p = 0.034 < 0.05 in AOI-1 and p = 0.032 < 0.05 in AOI-2), fixation duration ( p = 0.043 < 0.05 in AOI-1 and p = 0.014 < 0.05 in AOI-2), and saccade count ( p = 0.086 < 0.1 in AOI-1 and p = 0.054 < 0.1 in AOI-2). This was determined by the fixation count ( p = 0.024 < 0.05 in AOI-1 and p = 0.034 < 0.05 in AOI-2), fixation duration ( p = 0.036 < 0.05 in AOI-1 and p = 0.047 < 0.05 in AOI-2), and saccade duration ( p = 0.05 ≤ 0.05 in AOI-1 and p = 0.042 < 0.05 in AOI-2) in poor-visibility scenes. In the remaining scenes, the SA could not be measured using eye movements alone. This study lays a foundation for the cognitive mechanism recognition of pilots based on SA via eye-tracking technology, which provides a reference to establish cognitive competency standards in preliminary pilot screenings.

Download Full-text

Charting the Edges of Human Performance

MATEC Web of Conferences ◽

10.1051/matecconf/201930406007 ◽

2019 ◽

Vol 304 ◽

pp. 06007

Author(s):

Barry Kirwan ◽

Matthias Wies ◽

Rebecca Charles ◽

Charles-Alban Dormoy ◽

Theodore Letouze ◽

...

Keyword(s):

Heart Rate ◽

Eye Tracking ◽

Real Time ◽

Situation Awareness ◽

Human Performance ◽

Human Machine Interface ◽

Pilot Performance ◽

Horizon 2020 ◽

Safety Programme ◽

Machine Interface

In the Horizon 2020 funded Future Sky Safety programme, the Human Performance Envelope project pushed airline pilots to the edges of their performance in real-time cockpit simulations, by increasing stress and workload, and decreasing situation awareness. The aim was to find out how such factors interact, and to detect the edges of human performance where some form of automation support should be employed to ensure safe continued flight. A battery of measures was used, from behavioural to physiological (e.g. heart rate, eye tracking and pupil dilation), to monitoring pilot performance in real time. Several measures – e.g. heart rate, heart rate variability, eye tracking, cognitive walkthrough, and Human Machine Interface (HMI) usability analysis – proved to be useful and relatively robust in detecting performance degradation, and determining where changes in information presentation are required to better support pilot performance in challenging situations. These results led to proposed changes in a prototype future cockpit human-machine interface, which were subsequently validated in a final simulation. The results also informed the development of a ‘Smart-Vest’ that can be worn by pilots to monitor a range of signals linked to performance.

Download Full-text