Effect of Face-to-Face vs Virtual Reality Training on Cardiopulmonary Resuscitation Quality: A Randomized Clinical Trial
Effect of Face-to-Face vs Virtual Reality Training on Cardiopulmonary Resuscitation Quality: A Randomized Clinical Trial
复制标题
DOI：
10.1001/jamacardio.2019.4992
复制
发表时间：
2020-03-01
期刊：
影响因子：
24
通讯作者：
Brouwer, Marc A.
中科院分区：
文献类型：
--
作者：
Nas, Joris;Thannhauser, Jos;Brouwer, Marc A.
这项随机非劣效性试验比较了虚拟现实与面对面心肺复苏（CPR）培训对CPR质量的影响，通过CPR模型上的胸部按压深度和速率来测量CPR质量。Key PointsPreview虚拟现实（VR）心肺复苏（CPR）培训是否会导致CPR质量和性能与面对面培训相当？结果：在这项随机非劣效性试验中，381例受试者中，VR训练导致胸外按压率非劣效性，但按压深度劣效性; VR训练中符合指南认可的按压深度或速率建议的受试者比例较低，尽管总体上超过50%的受试者符合这些标准。心肺复苏情景表现和胸外按压分数更差，但倾斜比面对面训练更不常见。虽然VR训练可能会导致胸部按压率类似于面对面的培训，它需要进一步发展，以实现可比的压缩深度和整体CPR性能。重要性旁观者心肺复苏术（CPR）是心脏骤停后的生存至关重要，但在大多数情况下不进行。新的、低成本的、易于使用的培训方法，如虚拟现实（VR），可能会覆盖更广泛的目标人群，但缺乏关于心肺复苏术技能的数据。目的比较虚拟现实技术与面对面心肺复苏训练对心肺复苏质量的影响。设计、设置和样本：前瞻性、随机、开放盲法终点设计的随机非劣效性试验。参与者是来自荷兰低地音乐节（2019年8月16日至18日）科学部分的成年与会者。分析开始于2019年9月。干预两个标准化的20分钟心肺复苏术和自动体外除颤器用途：人工呼吸器引导的面对面培训或使用复苏理事会（英国）认可的智能手机应用程序的VR培训。主要结果和测量在培训后的标准化CPR场景中，我们评估了主要结果CPR质量，使用CPR人体模型测量胸部按压深度和速率。总体心肺复苏术的表现由检查者评估，对研究组设盲，使用欧洲复苏委员会认可的检查表（最高评分，13分）。其他次要结局包括胸外按压分数、平均深度（50 mm-60 mm）或速率（100 min（-1）-120 min（-1））在指南范围内的受试者比例以及完全释放的按压比例。结果共有381名参与者被随机分组：216名女性（57%）;中位（四分位距[IQR]）年龄为26（22-31）岁。VR App（n=190 [49.9%]）劣于面对面培训（n=191 [50.1%]）胸外按压深度（平均[SD]，VR：49[10] mm vs面对面：57[5] mm;平均[95% CI]差异，-8 [-9至-6] mm），胸外按压率非劣效（平均[SD]：VR：114 [12] min（-1）vs面对面：109 [12] min（-1）;平均[95% CI]差异，6 [3 - 8] min（-1））。VR组的总体CPR表现评分较低（中位数[IQR]，10 [8-12] vs 12 [12-13]; P
This randomized noninferiority trial compares the effect of virtual reality vs face-to-face cardiopulmonary resuscitation (CPR) training on CPR quality measured by chest compression depth and rate on CPR manikins.Key PointsQuestionDoes virtual reality (VR) cardiopulmonary resuscitation (CPR) training result in CPR quality and performance comparable with face-to-face training? FindingsIn this randomized noninferiority trial of381 individuals, VR training resulted in noninferior chest compression rate but inferior compression depth; proportions of participants fulfilling guideline-endorsed compression depth or rate recommendations were lower in VR training, although overall these criteria were met in more than 50%. Cardiopulmonary resuscitation scenario performance and chest compression fraction were worse, but leaning was less common than in face-to-face training. MeaningAlthough VR training may lead to chest compression rates similar to face-to-face training, it needs further development to achieve comparable compression depth and overall CPR performance.ImportanceBystander 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. ObjectiveTo compare CPR quality between VR and face-to-face CPR training. Design, Setting, and ParticipantsRandomized 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. InterventionsTwo 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. ResultsA 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