VR simulation training in acute cardiovascular education

Virtual reality is a novel, yet fast-evolving technology that has a broad range of applications within medicine. A range of VR-based simulators have been developed over the past few years to improve training of healthcare providers in the field of cardiovascular interventions, recently reviewed by (Mahtab & Egorova, 2022). Despite the validation of VR in several studies, robust data on the efficacy and (cost-)efficiency of VR in a real world setting is still missing.

This working group will
1) focus on the steps required for the successful implementation of VR in the training of cardiovascular professionals, and will gather evidence on the effectiveness of this novel approach. 
2) facilitate and support the structured dissemination and integration of these simulator supported programs in the clinical cardiovascular practice and regular educational curricula.
3) we intend to develop an international network to achieve the aforementioned goals and to further explore the needs of the daily clinical practice related to simulation training.

(Preliminary) list of members:

  • Dr. E.A.F. Mahtab, department of cardiothoracic surgery Erasmus MC, applicant

  • Drs. S. Max, PhD  department of cardiothoracic surgery Erasmus MC

  • Prof. Dr. J. Braun, department of cardiothoracic surgery LUMC, co-applicant

  • Prof. Dr. R. Lorusso, department of cardiothoracic surgery MUMC

  • Dr. M. Regeer, department of cardiology LUMC

  • Dr. ing. N. Bruining, department of cardiology EMC

Honourable members:

  • Prof. Dr. M. Klinceva, Department of cardiology Zan Mitriv Clinic Rep. of North Macedonia
  • Prof. Dr. J. Dunning, BM Bch, FRCS (Cth), Consultant Thoracic Surgeon (James Cook University Hospital, Middlesbrough, UK)
  • Prof. Bhuvaneswari Bibleraaj, Professor in Nursing/Surgical Practice and Postdoctoral NIHR Research Fellow School of Nursing and Midwifery Fredrick campus University of Salford, UK
  • Prof. Dr. B. Kaufman department of Intensive Care and Anaesthesiology  (New York University Langone Health, USA)

Start date: January 2024

Below are few examples of our VR-based simulators and integrated educational systems:

” VRCPR: VR-based simulator for cardio-pulmonary resuscitation (CPR) after cardiac surgery.

Adequate implementation of the international protocols has been shown to result in about 80% chance of survival post resuscitation (Dunning et al., 2009). This can be achieved by adequate and repetitive VRCPR simulator supported training of all the involved staff, with a

specific focus on residents and allied healthcare professionals.  Practicing the protocolized steps in a range of immersive and interactive scenarios is expected to contribute to team performance in real life acute situations. Ultimately, this program can work synergistically with the current certified A(C)LS programs, overcoming some of the practical challenges, i.e. having to be physically present, saving time, money, and the emissions associated with travel.

” VR-ECC modalities: this concerns VR-based extra corporeal circulatory (ECC) support devices such as the heart lung machine, ECMO (extra corporeal membrane oxygenation), ECLS (extra corporeal life support) that are needed for patients who require surgical bypass on a heart- lung machine, or require ECMO during an operation, resuscitation (ECLS) or otherwise. We are currently developing our interactive simulation program (VR-ECC, VR-ECMO) for trainee perfusionists and trainees from other related fields such as, cardiology, cardio-thoracic surgery, Intensive Care and other allied health care in order to reinforce the required steps, and train them for specific scenarios requiring analytical troubleshooting skills to achieve and maintain sufficient perfusion of the patient. Successful execution of this program will contribute towards a safer and more effective implementation of ECC, ECMO and ECLS in clinical practice, thereby contributing to patient outcomes.

” VR-based scrub nurse simulator (VR-CTSN) is another example within the scope of this program. In the Netherlands the shortage of health care providers in 2023 is around 60.000 and this number will likely increase to more than 160.000 by the year 2032, according to the Dutch authorities (www.igj.nl). This shortage is much more pronounced for the specialized nurses such as the operating room scrub nurses. There is a current unmet need for effective and timely training of these specialized nurses. A VR-based simulator (VR-CTSN) where the scrub room nurses can train their skills in a realistic way, without the live presence of a tutor in an “on demand” fashion can address specific challenges of the training.

We expect that these VR based educational systems will, by means of an iterative process of development, not only match the quality of conventional training, but surpass it, and enable an unparalleled level of flexibility and immersion for the trainee and trainers. By enabling trainees to practice repeatedly using relatively affordable and portable VR hardware, they will be better prepared for daily practice than they may otherwise have been had they only had access to training that required an instructor to be present, a room with a simulated monitor, devices, high-fidelity mannequins, etc. Cost savings and accessibility, particularly for centres that have more limited resources available, are distinct advantages of VR supported learning.


  1. Promoting and expanding an (inter-)national research network focusing on the validity and implementation of VR-based simulators in regular practice.
  2. Implementing the introduction and utilization of VR-simulators in the current (inter-) national educational and clinical training system.
  3. Building partnerships with institutions and educational bodies with the aim of successful implementation of VR-based simulators for training purposes. A priority will be given to dedicated and integrated VR-simulators for the curriculum of cardiology, cardiothoracic surgery, acute care (IC/CCU), perfusionists, and scrub nurses.
  4. Facilitating a dialogue with health care stakeholders as well as health care educational institutions to improve the use of VR simulators in training, and further promote the trainee and trainer empowerment.

Intended activities:

  1. Executing international research on validity of VR-based simulators.
  2. Establishing (inter) national research- and implementation networks to facilitate embedding of VR-based simulation training in current and future clinical educational programs.
  3. Applying for and coordinating joint (inter-)national research grant applications.
  4. Organizing a dedicated symposium during NVVC / NVT meeting to disseminate the VR-based simulators as well as the philosophy of VR-based simulation based training.

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