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

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.

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.

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).

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