Effectiveness of Extended Reality CPR Training Methods

Comparison of Extended Reality and Conventional Methods of Basic Life Support Training: Protocol for a Multinational Pragmatic Clinical Trial (XR BLS Trial)

The aim of this study is to explore the efficacy and safety of the extended reality (XR)-based basic life support (BLS) training.

Study Overview

• Status: Completed
• Conditions: Virtual Reality; Basic Cardiac Life Support
• Intervention / Treatment: Other: conventional CPR training; Other: extended-reality CPR training

Detailed Description

Conventional CPR training is based on the use of a manikin and a training video. Though several feedback devices have been developed to improve the effectiveness of the training, they were neither realistic nor immersive. In addition, in conventional training programs, trainees are constrained in terms of time and location, as they are usually kept to a schedule.

Virtual reality (VR) technology, which was designed to maximize immersion, could be used to overcome those limitations, which in turn may improve the effectiveness of CPR training. However, even with VR technology, procedures such as chest compressions, ventilation, and defibrillation cannot be implemented as in the real world. Extended reality (XR), which combines the virtual and real worlds, could overcome these limitations by facilitating the use of real-world manikins in the virtual environment.

• Study Type: Interventional
• Enrollment (Actual): 154
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Korea, Republic of
  • Gyeonggi-do
    • Seongnam-si, Gyeonggi-do, Korea, Republic of, 13620
      • Seoul National University Bundang Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Individuals who are not healthcare providers and are 18 years old or older

Exclusion Criteria:

Participants who

• are not capable of performing either the training or the CPR test due to physical or cognitive limitations
• have upper extremity injuries
• are pregnant
• experience dizziness, headache, or motion sickness during the 2-minute XR device adaptation period that prevents them from participating in the simulation study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Sham Comparator: Conventional group; Conventional CPR training consists of a BLS video and a manikin equipped with a feedback device.	Other: conventional CPR training; conventional CPR training with video
Active Comparator: XR group; The XR group participants will be provided training via the XR BLS module and are allotted an additional 2 minutes that is needed to adapt to the XR equipment.	Other: extended-reality CPR training; extended-reality technologies based CPR training module

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
mean compression depth, mm	compression depth	Test sessions on day 1 (during 5 minutes) after 1 hour training

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the total number of chest compressions (n)	The total number of chest compressions	Test sessions on day 1 (during 5 minutes) after 1 hour training
the mean chest compression depth(mm)	compression depth between 5cm and 6cm	Test sessions on day 1 (during 5 minutes) after 1 hour training
correct hand position (n, percent)	The American Heart Association (AHA) guidelines describe the correct hand position for chest compression as the lower half of the victim's sternum in the centre of the chest, between the nipples.	Test sessions on day 1 (during 5 minutes) after 1 hour training
adequate compression depth (n, percent)	compression depth between 5cm and 6cm	Test sessions on day 1 (during 5 minutes) after 1 hour training
compression and full release (n, percent)	full release after chest compression	Test sessions on day 1 (during 5 minutes) after 1 hour training
mean compression rate (number per minute)	mean compression rate	Test sessions on day 1 (during 5 minutes) after 1 hour training
adequate compression rate (percent)	compression rate between 100 and 120 per minute	Test sessions on day 1 (during 5 minutes) after 1 hour training
adequate compression depth and rate (percent)	adequate compression death and rate, simultaneously	Test sessions on day 1 (during 5 minutes) after 1 hour training
hands-off time (sec)	Interruptions of chest compressions during cardiopulmonary resuscitation	Test sessions on day 1 (during 5 minutes) after 1 hour training
The time interval from arrival on the scene to the first chest compression (sec)	The time interval from arrival on the scene to the first chest compression.	Test sessions on day 1 (during 5 minutes) after 1 hour training
AED use	Done/Not done	Test sessions on day 1 (during 5 minutes) after 1 hour training
Correct AED use	Yes/No	Test sessions on day 1 (during 5 minutes) after 1 hour training
Time from powering on the AED to defibrillation (sec)	Time from powering on the AED to defibrillation (sec)	Test sessions on day 1 (during 5 minutes) after 1 hour training
Time from checking for a response to defibrillation (sec)	Time from checking for a response to defibrillation (sec)	Test sessions on day 1 (during 5 minutes) after 1 hour training

Collaborators and Investigators

• Sponsor: Seoul National University Hospital
• Collaborators: Seoul National University Bundang Hospital; Children's Hospital Los Angeles; Royal Manchester Children's Hospital
• Investigators: Study Director: You Hwan Jo, PhD, Seoul National University Bundang Hospital

Publications and helpful links

General Publications

• Iwashyna TJ. Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med. 2010 Aug 3;153(3):204-5. doi: 10.7326/0003-4819-153-3-201008030-00013. No abstract available.
• Semeraro F, Frisoli A, Loconsole C, Banno F, Tammaro G, Imbriaco G, Marchetti L, Cerchiari EL. Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: a randomised crossover mannequin pilot study. Resuscitation. 2013 Apr;84(4):501-7. doi: 10.1016/j.resuscitation.2012.12.006. Epub 2012 Dec 10.
• Semeraro F, Taggi F, Tammaro G, Imbriaco G, Marchetti L, Cerchiari EL. iCPR: a new application of high-quality cardiopulmonary resuscitation training. Resuscitation. 2011 Apr;82(4):436-41. doi: 10.1016/j.resuscitation.2010.11.023. Epub 2011 Jan 11.
• Semeraro F, Frisoli A, Bergamasco M, Cerchiari EL. Virtual reality enhanced mannequin (VREM) that is well received by resuscitation experts. Resuscitation. 2009 Apr;80(4):489-92. doi: 10.1016/j.resuscitation.2008.12.016. Epub 2009 Feb 8.
• Deakin CD. The chain of survival: Not all links are equal. Resuscitation. 2018 May;126:80-82. doi: 10.1016/j.resuscitation.2018.02.012. Epub 2018 Feb 19.
• Brady WJ, Mattu A, Slovis CM. Lay Responder Care for an Adult with Out-of-Hospital Cardiac Arrest. N Engl J Med. 2019 Dec 5;381(23):2242-2251. doi: 10.1056/NEJMra1802529. No abstract available.
• Ro YS, Shin SD, Song KJ, Hong SO, Kim YT, Cho SI. Bystander cardiopulmonary resuscitation training experience and self-efficacy of age and gender group: a nationwide community survey. Am J Emerg Med. 2016 Aug;34(8):1331-7. doi: 10.1016/j.ajem.2015.12.001. Epub 2015 Dec 7.
• Andrews C, Southworth MK, Silva JNA, Silva JR. Extended Reality in Medical Practice. Curr Treat Options Cardiovasc Med. 2019 Mar 30;21(4):18. doi: 10.1007/s11936-019-0722-7.
• Nas J, Thannhauser J, Vart P, van Geuns RJ, Muijsers HEC, Mol JQ, Aarts GWA, Konijnenberg LSF, Gommans DHF, Ahoud-Schoenmakers SGAM, Vos JL, van Royen N, Bonnes JL, Brouwer MA. Effect of Face-to-Face vs Virtual Reality Training on Cardiopulmonary Resuscitation Quality: A Randomized Clinical Trial. JAMA Cardiol. 2020 Mar 1;5(3):328-335. doi: 10.1001/jamacardio.2019.4992.
• Anderson R, Sebaldt A, Lin Y, Cheng A. Optimal training frequency for acquisition and retention of high-quality CPR skills: A randomized trial. Resuscitation. 2019 Feb;135:153-161. doi: 10.1016/j.resuscitation.2018.10.033. Epub 2018 Nov 2.
• Bylow H, Karlsson T, Claesson A, Lepp M, Lindqvist J, Herlitz J. Self-learning training versus instructor-led training for basic life support: A cluster randomised trial. Resuscitation. 2019 Jun;139:122-132. doi: 10.1016/j.resuscitation.2019.03.026. Epub 2019 Mar 26.
• Roppolo LP, Pepe PE, Campbell L, Ohman K, Kulkarni H, Miller R, Idris A, Bean L, Bettes TN, Idris AH. Prospective, randomized trial of the effectiveness and retention of 30-min layperson training for cardiopulmonary resuscitation and automated external defibrillators: The American Airlines Study. Resuscitation. 2007 Aug;74(2):276-85. doi: 10.1016/j.resuscitation.2006.12.017. Epub 2007 Apr 23.
• Zapletal B, Greif R, Stumpf D, Nierscher FJ, Frantal S, Haugk M, Ruetzler K, Schlimp C, Fischer H. Comparing three CPR feedback devices and standard BLS in a single rescuer scenario: a randomised simulation study. Resuscitation. 2014 Apr;85(4):560-6. doi: 10.1016/j.resuscitation.2013.10.028. Epub 2013 Nov 8.
• Park S, Lee G. Full-immersion virtual reality: Adverse effects related to static balance. Neurosci Lett. 2020 Aug 10;733:134974. doi: 10.1016/j.neulet.2020.134974. Epub 2020 Apr 12.
• Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, Berg RA, Bradley SM, Brooks SC, Cheng A, Escobedo M, Flores GE, Girotra S, Hsu A, Kamath-Rayne BD, Lee HC, Lehotsky RE, Mancini ME, Merchant RM, Nadkarni VM, Panchal AR, Peberdy MAR, Raymond TT, Walsh B, Wang DS, Zelop CM, Topjian AA; American Heart Association ECC Interim COVID Guidance Authors. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. 2020 Jun 23;141(25):e933-e943. doi: 10.1161/CIRCULATIONAHA.120.047463. Epub 2020 Apr 9. No abstract available.
• Nolan JP, Monsieurs KG, Bossaert L, Bottiger BW, Greif R, Lott C, Madar J, Olasveengen TM, Roehr CC, Semeraro F, Soar J, Van de Voorde P, Zideman DA, Perkins GD; European Resuscitation Council COVID-Guideline Writing Groups. European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation. 2020 Aug;153:45-55. doi: 10.1016/j.resuscitation.2020.06.001. Epub 2020 Jun 7.
• Craig-Brangan KJ, Day MP. Update: AHA guidelines for CPR and emergency cardiovascular care. Nursing. 2020 Jun;50(6):58-61. doi: 10.1097/01.NURSE.0000659320.66070.a9.
• Riggs M, Franklin R, Saylany L. Associations between cardiopulmonary resuscitation (CPR) knowledge, self-efficacy, training history and willingness to perform CPR and CPR psychomotor skills: A systematic review. Resuscitation. 2019 May;138:259-272. doi: 10.1016/j.resuscitation.2019.03.019. Epub 2019 Mar 27.
• Stiell IG, Brown SP, Nichol G, Cheskes S, Vaillancourt C, Callaway CW, Morrison LJ, Christenson J, Aufderheide TP, Davis DP, Free C, Hostler D, Stouffer JA, Idris AH; Resuscitation Outcomes Consortium Investigators. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation. 2014 Nov 25;130(22):1962-70. doi: 10.1161/CIRCULATIONAHA.114.008671. Epub 2014 Sep 24.
• Lee DK, Im CW, Jo YH, Chang T, Song JL, Luu C, Mackinnon R, Pillai S, Lee CN, Jheon S, Ahn S, Won SH. Comparison of extended reality and conventional methods of basic life support training: protocol for a multinational, pragmatic, noninferiority, randomised clinical trial (XR BLS trial). Trials. 2021 Dec 20;22(1):946. doi: 10.1186/s13063-021-05908-z.
• Grasner JT, Lefering R, Koster RW, Masterson S, Bottiger BW, Herlitz J, Wnent J, Tjelmeland IB, Ortiz FR, Maurer H, Baubin M, Mols P, Hadzibegovic I, Ioannides M, Skulec R, Wissenberg M, Salo A, Hubert H, Nikolaou NI, Loczi G, Svavarsdottir H, Semeraro F, Wright PJ, Clarens C, Pijls R, Cebula G, Correia VG, Cimpoesu D, Raffay V, Trenkler S, Markota A, Stromsoe A, Burkart R, Perkins GD, Bossaert LL; EuReCa ONE Collaborators. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016 Aug;105:188-95. doi: 10.1016/j.resuscitation.2016.06.004. Epub 2016 Jun 16. Erratum In: Resuscitation. 2016 Dec;109:145-146. doi: 10.1016/j.resuscitation.2016.10.001.

Study record dates

Study Major Dates

• Study Start (Actual): September 10, 2021
• Primary Completion (Actual): September 9, 2024
• Study Completion (Actual): September 9, 2024

Study Registration Dates

• First Submitted: January 29, 2021
• First Submitted That Met QC Criteria: January 29, 2021
• First Posted (Actual): February 3, 2021

Study Record Updates

• Last Update Posted (Estimated): November 26, 2024
• Last Update Submitted That Met QC Criteria: November 22, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: Virtual Reality; Education; Cardiopulmonary resuscitation; Extended Reality; Basic Cardiac Life Support
• Other Study ID Numbers: CBS2.0

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No