Abstract

Purpose This study evaluates the Visual Hemofilter, a novel decision-support and information transfer tool designed to assist with regional citrate anticoagulation (RCA) in hemofiltration. By representing hemofilter parameters and patient blood constituents as animated icons, the tool aims to improve clinicians’ interpretation of blood gas results and RCA reference tables. We hypothesized that the Visual Hemofilter would enhance clinical decision-making by enabling faster and more accurate therapy adjustments, increasing clinicians’ confidence in their decisions, and reducing cognitive workload compared to conventional methods.

Methods We conducted a prospective, randomized, computer-based simulation study across four intensive care units at the University Hospital Zurich. Twenty-six critical care professionals participated, each managing regional citrate anticoagulation (RCA) scenarios using either the Visual Hemofilter or conventional methods involving blood gas analysis and reference tables. Following each scenario, participants made therapy adjustments and rated their decision confidence and cognitive workload.

Results Use of the Visual Hemofilter significantly improved decision accuracy (odds ratio [OR] 3.96; 95% CI 2.03–7.73; p < 0.0001) and reduced decision time by an average of 33 seconds (mean difference –33.3 seconds; 95% CI –39.4 to –27.2; p < 0.0001). Participants also reported greater confidence in their decisions (OR 5.41; 95% CI 2.49–11.77; p < 0.0001) and experienced lower cognitive workload (mean difference –15.05 points on the NASA-TLX scale (National Aeronautics and Space Administration-Task Load Index); 95% CI –18.99 to –11.13; p < 0.0001).

Conclusions The Visual Hemofilter enhances clinical decision-making in RCA by increasing accuracy and speed, boosting decision confidence, and reducing cognitive workload. This technology has the potential to reduce errors and better support critical care professionals in managing complex treatment scenarios.

Competing Interest Statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: J.B.L. is the first named inventor of Visual Hemofilter technology, for which the University of Zurich holds patent applications and design protections potential royalties may follow successful commercialization. C.B.N. is an inventor of Visual Patient and Visual Patient Predictive technologies, for which the University of Zurich and Koninklijke Philips N.V. hold patents, patent applications, design protections, and trademarks. Joint development and licensing agreements exist with Philips Medizin Systeme Böblingen GmbH, Böblingen, Germany Koninklijke Philips N.V., Amsterdam, The Netherlands Philips Research/Philips Electronics Nederland BV, Eindhoven, The Netherlands and Philips USA, Cambridge, MA, USA. Within the framework of these agreements, C.B.N. receives travel support, lecturing, and consulting honoraria and royalties. C.B.N. is an inventor of Visual Clot technology, with patent applications, design protections, and trademarks held by the University of Zurich. In case of successful commercialization, C.B.N. may receive royalties. C.B.N. is an inventor of Visual Blood technology, for which the University of Zurich holds patent applications and design protections potential royalties may follow successful commercialization. C.B.N. received travel support, lecturing, and consulting honoraria from Instrumentation Laboratory-Werfen, Bedford, MA, USA. D.W.T. is the first named inventor of Visual Patient, Visual Patient Predictive, Visual Heart technologies, for which the University of Zurich and Koninklijke Philips N.V. hold patents, patent applications, design protections, and trademarks. Joint development and licensing agreements exist with Philips Medizin Systeme Böblingen GmbH, Böblingen, Germany Koninklijke Philips N.V., Amsterdam, The Netherlands Philips Research/Philips Electronics Nederland BV, Eindhoven, The Netherlands and Philips USA, Cambridge, MA, USA. Within the framework of these agreements, D.W.T. receives research funding, travel support, lecturing, consulting honoraria and royalties. D.W.T. holds a position on the Philips Patient Safety Advisory Board. D.W.T. is the first named inventor of Visual Clot technology, with patent applications, design protections, and trademarks held by the University of Zurich. In the event of successful commercialization, D.W.T. may receive royalties. D.W.T. is the first named inventor of Visual Blood technology, for which the University of Zurich holds patent applications and design protections potential royalties may follow successful commercialization. Additionally, D.W.T. received travel support, lecturing, and consulting honoraria from Instrumentation Laboratory?Werfen, Bedford, MA, USA, the Swiss Foundation for Anaesthesia Research in Zurich, Switzerland, and the International Symposium on Intensive Care and Emergency Medicine in Brussels, Belgium. D.W.T. is an inventor of Visual Hemofilter technology, with patent applications and design protections held by the University of Zurich. In case of successful commercialization, D.W.T. may receive royalties. The other authors report no conflicts of interest regarding this paper.

Funding Statement

Yes

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol was reviewed by the Ethics Committee of the Canton of Zurich, Switzerland, which issued a declaration of non-jurisdiction (BASEC-Nr. Req-2023-00415).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All relevant data underlying the findings of this study are publicly available. The supplementary video materials are available at Zenodo via the following DOI: https://doi.org/10.5281/zenodo.19552395). All other data are included within the manuscript and its Supporting Information files.

List of abbreviationsAKIAcute kidney injuryAGBArterial blood gasCiCa-CVVHDCitrate-based Continuous Veno-Venous HemodialysisCRRTContinuous renal replacement therapyFigFigureICUIntensive care unitIQRInterquartile rangesNASA-TLXNASA Task Load IndexRCARegional citrate anticoagulationSDStandard deviationVHFVisual Hemofilter