Resuscitation 84 (2013) 501–507 Contents lists available at SciVerse ScienceDirect Resuscitation jo u rn al hom epage : www.elsevier.com/locate/resuscitation Simulation and education Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: A randomised crossover mannequin pilot study  Federico Semeraro a,∗ , Antonio Frisoli b , Claudio Loconsole b , Filippo Bannò b , Gaetano Tammaro a , Guglielmo Imbriaco a , Luca Marchetti c , Erga L. Cerchiari a a Department of Anaesthesia and Intensive Care, Ospedale Maggiore, Bologna, Italy b PERCRO, Scuola Superiore Sant’Anna, Pisa, Italy c Studio Evil, Bologna, Italy a r t i c l e i n f o Article history: Received 8 March 2012 Received in revised form 8 November 2012 Accepted 3 December 2012 Keywords: Cardiopulmonary resuscitation Chest compression Quality CPR Kinect ® Motion detection Education Training Cardiac arrest Feedback device a b s t r a c t Introduction: Outcome after cardiac arrest is dependent on the quality of chest compressions (CC). A great number of devices have been developed to provide guidance during CPR. The present study evaluates a new CPR feedback system (Mini-VREM: Mini-Virtual Reality Enhanced Mannequin) designed to improve CC during training. Methods: Mini-VREM system consists of a Kinect ® (Microsoft, Redmond, WA, USA) motion sensing device and specifically developed software to provide audio–visual feedback. Mini-VREM was connected to a commercially available mannequin (Laerdal Medical, Stavanger, Norway). Eighty trainees (healthcare professionals and lay people) volunteered in this randomised crossover pilot study. All subjects performed a 2 min CC trial, 1 h pause and a second 2 min CC trial. The first group (FB/NFB, n = 40) performed CC with Mini-VREM feedback (FB) followed by CC without feedback (NFB). The second group (NFB/FB, n = 40) performed vice versa. Primary endpoints: adequate compression (compression rate between 100 and 120 min -1 and compression depth between 50 and 60 mm); compressions rate within 100–120 min -1 ; compressions depth within 50–60 mm. Results: When compared to the performance without feedback, with Mini-VREM feedback compressions were more adequate (FB 35.78% vs. NFB 7.27%, p < 0.001) and more compressions achieved target rate (FB 72.04% vs. 31.42%, p < 0.001) and target depth (FB 47.34% vs. 24.87%, p = 0.002). The participants perceived the system to be easy to use with effective feedback. Conclusions: The Mini-VREM system was able to improve significantly the CC performance by healthcare professionals and by lay people in a simulated CA scenario, in terms of compression rate and depth. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Cardiopulmonary resuscitation has a primary role in survival to cardiac arrest (CA) and training in Basic Life Support (BLS) has been developed worldwide by instructor-led training courses. A recent review provided good evidence to support alternative methods of training, including the use of lay instructors, self-directed learning and CPR feedback/prompt devices. 1 Tools analysing compressions and ventilations and providing feedback to the operator have been shown to improve CPR performance. 2 A recent article suggested implementing a CPR quality program using real-time CPR feed- back devices combined with post-event debriefing; this approach  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.12.006. ∗ Corresponding author. Tel.: +39 3336592670; fax: +39 0516478867. E-mail address: fsemeraro2008@gmail.com (F. Semeraro). proved to be more effective in improving CPR quality compared to current practices. 3 When tested on mannequins, the quality of CPR performed by lay people and by healthcare professionals tends to deteriorate significantly within a few months after training. 4,5 The quality of CPR is often poor in clinical settings, although the survival benefit of high-quality CPR has been well documented. 6,7 Perform- ing high-quality CPR during CA could improve patient survival, and a recent review suggested that prompting and feedback devices might improve performance in training and in clinical settings. 8 The 2010 European Resuscitation Council (ERC) guidelines emphasised the importance of high-quality, uninterrupted CPR specifying a target compression depth of 50–60 mm and a rate of 100–120 com- pressions per minute. 9 Consequently, a great number of devices have been developed to provide guidance during CPR 6,10–13 in both training and in clinical settings. The devices range in complexity from a simple metronome to more complex devices that monitor and provide combined audio–visual feedback on actual CPR per- formance. The feedback devices commonly used an accelerometer 0300-9572/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2012.12.006