Developing a Virtual Paediatric CRRT Simulator: Global Reach and Learning Insights.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2026-01-01 Epub Date: 2026-03-02 DOI:10.1159/000551262

Amrit Kirpalani, Cory Alec Manzo Anderson, Hannah Yassine, Janice A Tijssen, Paige Burgess

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引用次数: 0

Abstract

Introduction: Continuous renal replacement therapy (CRRT) is a high-stakes modality central to pediatric critical care, yet maintaining provider competency is challenging in many pediatric intensive care units due to low case volumes and limited access to structured training. Traditional high-fidelity simulation is effective but resource intensive, limiting scalability and global accessibility. Screen-based simulation offers a complementary, low-cost approach to address these educational gaps.

Methods: We developed the Paediatric CRRT Simulator (https://crrt-sim.netlify.app/), a free, browser-based platform comprising 21 interactive cases designed to emulate real-world CRRT decision-making. The simulator uses modular clinical decision trees and adaptive learning principles, with case progression mapped to the Revised Bloom's Taxonomy. Aggregated, anonymized Google Firebase Analytics data were analyzed for users accessing the platform between July 9 and October 6, 2025. Metrics included unique users, session frequency, geographic distribution, and case-level clinical decisions. Countries were classified by World Bank income categories.

Results: During the 90-day period, 2,578 unique users generated 3,761 sessions from 92 countries, including 25 low- and middle-income countries. The highest user activity originated from the USA (50.5%), Saudi Arabia (7.8%), Canada (7.1%), India (4.9%), and Brazil (3.7%). Forty-four percent of users returned for at least one additional session. Case-level analytics revealed significant practice variation: in a sepsis-associated acute kidney injury case (n = 1,651), anticoagulation selections were citrate 673/1,651 (40.8%), heparin 589/1,651 (35.7%), no anticoagulation 246/1,651 (14.9%), and epoprostenol 84/1,651 (5.1%) (χ2 = 214.8, p < 0.001). In a hemodynamic safety scenario involving a small child (n = 650), saline priming was selected in 446 (68.6%) of cases instead of blood (165/650 [25.4%]) or albumin (39/650 [6.0%]) despite high extracorporeal circuit volume (χ2 = 487.7, p < 0.001).

Conclusions: Screen-based CRRT simulation represents a scalable approach to support pediatric critical care training and inform future curriculum development.

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开发虚拟儿科CRRT模拟器：全球覆盖和学习见解。

持续肾脏替代疗法（CRRT）是一种高风险的儿科重症监护核心模式，但由于病例量低和获得结构化培训的机会有限，在许多儿科重症监护病房保持提供者的能力是具有挑战性的。传统的高保真仿真是有效的，但资源密集，限制了可扩展性和全局可访问性。基于屏幕的模拟提供了一种补充的、低成本的方法来解决这些教育差距。我们开发了儿科CRRT模拟器（https://crrt-sim.netlify.app/），这是一个免费的基于浏览器的平台，包含21个交互式案例，旨在模拟现实世界的CRRT决策。该模拟器使用模块化临床决策树和自适应学习原则，并将病例进展映射到修订的布鲁姆分类法。谷歌Firebase Analytics对2025年7月9日至10月6日期间访问该平台的用户进行了汇总、匿名数据分析。指标包括唯一用户、会话频率、地理分布和病例级临床决策。各国按照世界银行的收入类别进行分类。在90天的时间里，来自92个国家（包括25个低收入和中等收入国家）的2578名独立用户创造了3761次游戏体验。最高的用户活跃度来自美国（50.5%）、沙特阿拉伯（7.8%）、加拿大（7.1%）、印度（4.9%）和巴西（3.7%）。44%的用户至少会再玩一次游戏。病例水平分析显示了显著的实践差异：在1例败血症相关急性肾损伤病例（n = 1651）中，抗凝剂选择为柠檬酸盐673/1651（40.8%）、肝素589/1651（35.7%）、无抗凝剂249 /1651（14.9%）和环氧前列醇84/1651 (5.1%)（χ²= 214.8,p < 0.001）。．在涉及儿童的血流动力学安全场景（n =650）中，尽管体外循环容量很大，但仍有446例（68.6%）病例选择生理盐水启动，而不是血液[165/650(25.4%)]或白蛋白[39/650 (6.0%)]

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.