Evaluation of Mixed Reality Cardiopulmonary Resuscitation Training (HEROS 4)

Evaluation of Efficacy and Effectiveness of Mixed Reality Cardiopulmonary Resuscitation Training

<Study Design> This study is a cluster-randomized, stratified, non-inferiority trial designed to evaluate the feasibility, efficacy, and educational effectiveness of HEROS 4.0, a mixed-reality (MR)-based cardiopulmonary resuscitation (CPR) training system, compared with conventional instructor-led CPR training.

<Objective & Hypothesis> The primary objective is to determine whether MR-based HEROS 4.0 CPR training is non-inferior to standard video- and instructor-based CPR training in improving CPR performance quality. The central hypothesis is that participants trained using HEROS 4.0 will achieve comparable CPR quality to those trained using traditional methods, while benefiting from enhanced immersion, scalability, and accessibility.

<Participants> A total of 120 adults aged 18-50 years who have not received CPR training within the previous 12 months will be recruited. Participants will be assigned to one of two clusters and randomized in a 1:1 ratio to either the HEROS 4.0 MR training group or the conventional CPR training group.

<Intervention & Control>

Participants will undergo CPR training according to their assigned group:

Intervention group (HEROS 4.0):

Participants will receive a two-stage CPR training program consisting of pre-training and on-site MR-based training. As pre-training, participants will be instructed to watch a 40-minute instructional video (conventional CPR training group video) at home prior to their visit. After completing the pre-training, participants will undergo 20 minutes of MR-based CPR training using the HEROS 4.0 system in a dedicated CPR training booth.

Control group (Conventional CPR training):

Participants will receive 60 minutes of standard CPR education delivered through instructional videos and in-person instructor guidance, reflecting current community CPR training practice.

<Outcomes> Immediately after training, all participants will undergo a standardized cardiac arrest simulation using a CPR quality-measurement manikin. This simulation will assess objective CPR performance metrics as well as subjective outcomes through questionnaires.

To evaluate knowledge retention and skill durability, all assessments will be repeated 6 months after training using the same simulation scenario and outcome measures.

The primary outcome is chest compression fraction measured during the standardized simulated cardiac arrest scenario.

Secondary outcomes include quantitative measures of CPR quality and participant-reported outcomes based on survey.

Study Overview

• Status: Recruiting
• Conditions: Cardiac Arrest (CA); Basic Life Support Training Course; Cardiopulmonary Resuscitation (CPR)
• Intervention / Treatment: Other: HEROS 4.0; Other: Conventional CPR training

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dong Hyun Choi, MD, PhD; Phone Number: 82-2-2072-4646; Email: donghyun369@naver.com

Study Locations

• South Korea
  • Nowon-gu
    • Seoul, Nowon-gu, South Korea, 01689
      • Recruiting
      • Nowon-gu Public Health Center
      • Contact: Dong Hyun Choi, MD, PhD; Phone Number: 82-2-2072-4646; Email: donghyun369@naver.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adults aged 18-50 years who have not received CPR training within the previous 12 months.

Exclusion Criteria:

• Healthcare professionals
• Individuals unable to safely tolerate MR equipment (e.g. motion sickness)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: HEROS 4.0; Participants will receive a two-stage CPR training program consisting of pre-training and on-site MR-based training. As pre-training, participants will be instructed to watch a 40-minute instructional video (conventional CPR training group video) at home prior to their visit. After completing the pre-training, participants will undergo 20 minutes of MR-based CPR training using the HEROS 4.0 system in a dedicated CPR training booth.	Other: HEROS 4.0; Participants will receive a two-stage CPR training program consisting of pre-training and on-site MR-based training. As pre-training, participants will be instructed to watch a 40-minute instructional video (conventional CPR training group video) at home prior to their visit. After completing the pre-training, participants will undergo 20 minutes of MR-based CPR training using the HEROS 4.0 system in a dedicated CPR training booth. The MR-based CPR training content consists of cardiac arrest recognition, calling emergency medical services, chest compressions, and use of an automated external defibrillator, while minimizing interruptions in chest compressions.
Active Comparator: Conventional CPR training; Participants will receive 60 minutes of standard CPR education delivered through instructional videos and in-person instructor guidance, reflecting current community CPR training practice.	Other: Conventional CPR training; Participants will receive 60 minutes of standard CPR education delivered through instructional videos and in-person instructor guidance, reflecting current community CPR training practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chest compression fraction	Chest compression fraction (CCF) is defined as the proportion of total resuscitation time during which chest compressions are actively delivered. Chest compression quality metrics including CCF will be measured during a standardized cardiac arrest simulation using a CPR quality-measurement manikin.	(1) Immediately after training and (2) at 6-month follow-up.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean chest compression depth	The average depth of all chest compressions delivered during the simulated resuscitation.	(1) Immediately after training and (2) at 6-month follow up.
Mean chest compression rate	The average number of chest compressions performed per minute during the CPR simulation.	(1) Immediately after training and (2) at 6-month follow up.
Proportion of compressions with adequate depth	The percentage of chest compressions that meet guideline-recommended depth (5-6 cm) criteria during the simulation.	(1) Immediately after training and (2) at 6-month follow up.
Proportion of compressions with adequate rate	The percentage of chest compressions that fall within the guideline-recommended (100-120 compressions per minute) compression rate range.	(1) Immediately after training and (2) at 6-month follow up.
Overall basic life support performance	Measurement of basic life support performance during standardized cardiac arrest simulation using the following checklist items including: Check response / Assess breathing / Call EMS and get help / Chest compressions / Activate AED and attach pads / Stand clear / Deliver shock / Minimize CPR interruptions /	(1) Immediately after training and (2) at 6-month follow up.
CPR self-efficacy	Participants' self-efficacy in performing CPR will be evaluated using a modified version of the Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES), consisting of 15 items rated on a 11-point Likert scale (converted to 0-100 scale), with higher scores indicating greater self-efficacy.	(1) Before training, (2) immediately after training and (3) at 6-month follow-up.
System Usability Scale	The usability of the MR-based CPR Training program will be evaluated using the System Usability Scale (SUS), a validated 10-item questionnaire rated on a 5-point Likert scale, with higher scores indicating better usability. This assessment will be conducted only in the experimental group.	Immediately after training

Collaborators and Investigators

• Sponsor: Seoul National University Hospital
• Investigators: Study Chair: Sang Do Shin, MD, PhD, Seoul National University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: January 15, 2026
• First Submitted That Met QC Criteria: January 15, 2026
• First Posted (Actual): January 23, 2026

Study Record Updates

• Last Update Posted (Actual): April 28, 2026
• Last Update Submitted That Met QC Criteria: April 26, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Heart Arrest
• Other Study ID Numbers: 2401-048-1500

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