Effect of Face-to-Face vs Virtual Reality Training on Cardiopulmonary Resuscitation Quality

Abstract

Bystander cardiopulmonary resuscitation (CPR) is crucial for survival after cardiac arrest but not performed in most cases. New, low-cost, and easily accessible training methods, such as virtual reality (VR), may reach broader target populations, but data on achieved CPR skills are lacking. OBJECTIVE To compare CPR quality between VR and face-to-face CPR training. DESIGN, SETTING, AND PARTICIPANTS Randomized noninferiority trial with a prospective randomized open blinded end point design. Participants were adult attendees from the science section of the Lowlands Music Festival (August 16 to 18, 2019) in the Netherlands. Analysis began September 2019. INTERVENTIONS Two standardized 20-minute protocols on CPR and automated external defibrillator use: instructor-led face-to-face training or VR training using a smartphone app endorsed by the Resuscitation Council (United Kingdom). MAIN OUTCOMES AND MEASURESDuring a standardized CPR scenario following the training, we assessed the primary outcome CPR quality, measured as chest compression depth and rate using CPR manikins. Overall CPR performance was assessed by examiners, blinded for study groups, using a European Resuscitation Council-endorsed checklist (maximum score, 13). Additional secondary outcomes were chest compression fraction, proportions of participants with mean depth (50 mm-60 mm) or rate (100 min −1 -120 min −1 ) within guideline ranges, and proportions compressions with full release. RESULTS A total of 381 participants were randomized: 216 women (57%); median (interquartile range [IQR]) age, 26 (22-31) years. The VR app (n = 190 [49.9%]) was inferior to face-to-face training (n = 191 [50.1%]) for chest compression depth (mean [SD], VR: 49 [10] mm vs face to face: 57 [5] mm; mean [95% CI] difference, −8 [−9 to −6] mm), and noninferior for chest compression rate (mean [SD]: VR: 114 [12] min −1 vs face to face: 109 [12] min −1 ; mean [95% CI] difference, 6 [3 to 8] min −1 ). The VR group had lower overall CPR performance scores (median [IQR], 10 [8-12] vs 12 [12-13]; P < .001). Chest compression fraction (median [IQR], 61% [52%-66%] vs 67% [62%-71%]; P < .001) and proportions of participants fulfilling depth (51% [n = 89] vs 75% [n = 133], P < .001) and rate (50% [n = 87] vs 63% [n = 111], P = .01) requirements were also lower in the VR group. The proportion of compressions with full release was higher in the VR group (median [IQR], 98% [59%-100%] vs 88% [55%-99%]; P = .002). CONCLUSIONS AND RELEVANCE In this randomized noninferiority trial, VR training resulted in comparable chest compression rate but inferior compression depth compared with face-to-face training. Given the potential of VR training to reach a larger target population, further development is needed to achieve the compression depth and overall CPR skills acquired by face-to-face training.

Cardiopulmonary resuscitation training for high school students using an immersive 360‐degree virtual reality environment

“…Various VR training modalities have been developed for CPR training purposes (Aksoy, 2019; Bench, Winter, & Francis, 2019; Cerezo Espinosa et al ., 2019; Creutzfeldt, Hedman, Medin, Stengard, & Fellander‐Tsai, 2009; Keys, Luctkar‐Flude, Tyerman, Sears, & Woo, 2020; Khanal et al ., 2014; Leary et al ., 2019; Nas et al ., 2020; Rushton, Drumm, Campion, & O’Hare, 2020; Semeraro et al ., 2019; Youngblood et al ., 2007) The purpose of these modalities can be categorized into “increasing knowledge,” “training skill performances” and “increasing self‐confidence.”…”

“…However, other authors did not find a satisfactory outcome in terms of compression rate and ‐depth when compared to face‐to‐face training (Nas et al ., 2020). Leary and colleagues compared a VR CPR app with a standard CPR app in a randomized controlled trial.…”

Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: a systematic literature review comparing different training methodologies

“…However, DVD-based group had better average inflation volume (844 ml vs. 524 ml, p = 0.006) and chest compression depth (45 mm vs. 39 mm, p = 0.005). Netherland 2020 [ 37 ] Virtual reality CPR training vs. face-to-face CPR training Randomized Controlled Trial 381 Layperson No CPR performance The VR group was inferior to face-to-face training in chest compression depth (49 mm vs. 57 mm), chest compression fraction (61% vs. 67%, p < 0.001), proportion of participants fulfilling depth (51% vs. 75%, p < 0.001), and rate requirements (50% vs. 63%, p = 0.01), but superior in chest compression rate (114/min vs. 109/min) and compressions with full release (98% vs. 88%, p = 0.002). The VR group had lower overall scores (10 vs. 12, p < 0.001) as compared to the face-to-face group.…”

“…Moreover, variability was also noted in the standard of content taught between different training methods and within each training method as well. Although “Einlebenretten” (“save one life”) educational framework [ 20 ] and European Resuscitation Council (ERC) 2010 guidelines [ 21 , 34 ] were the two contents similar between standard and non-standard face to face CPR training, the standard training group also used contents from ERC 2005 guidelines [ 34 ], American Heart Association (AHA) Heartsaver Citizen CPR course [ 27 , 28 , 31 , 38 ], AHA 2010 guidelines [ 25 ], National Safety Council Adult CPR training program [ 29 ], HeartCode BLS course [ 33 ], Dutch Resuscitation Council course [ 37 ], and Danish Red Cross course [ 36 ]. Although the computer-based HeartCode BLS course [ 33 ] and National Center for Early Defibrillation course [ 27 ] were similar between hybrid and online CPR training methodology, the standard of content was also adopted from other sources in these instructional methods.…”

“…The VR group was inferior to face-to-face training in chest compression depth (49 mm vs. 57 mm), chest compression fraction (61% vs. 67%, p < 0.001), proportion of participants fulfilling depth (51% vs. 75%, p < 0.001), and rate requirements (50% vs. 63%, p = 0.01), but superior in chest compression rate (114/min vs. 109/min) and compressions with full release (98% vs. 88%, p = 0.002). The VR group had lower overall scores (10 vs. 12, p < 0.001) as compared to the face-to-face group [ 37 ]. 9.…”