125: Improving Cardiopulmonary Resuscitation Training With the Nintendo Wii™

Abstract

Quality chest compressions (CCs) are of paramount importance for survival after cardiac arrest. Utilization of commercially available, feedback capable, training devices has been shown to improve the quality of CCs. We sought to use a relatively inexpensive Nintendo Wii™ to improve the quality of CCs given by emergency physicians. This was a prospective, observational study to examine whether visual feedback using a Nintendo Wii™ could improve CC quality delivered by emergency physicians. 24 physicians from a major urban emergency medicine training program participated. A Wii™ remote was used to detect the dynamic position of an infrared light-emitting diode (LED) strapped to one hand of each participant. Data was transmitted from the Wii™ remote to a computer via Bluetooth™. Each participant performed three one-minute trials of CCs on a standard Laerdal training manikin. Visual feedback was provided only during the second one-minute trial in order to compare CC quality before, during, and after intervention with the Wii™. To minimize bias, the participants were blinded from observing each other while performing CCs. Quality CCs were defined using the 2005 American Heart Association guidelines for rate (100±10 CCs/minute) and depth (1.5-2 inches). An additional parameter used to define quality CCs was the allowance of full chest wall recoil after each CC. Statistical t-tests and analysis of variance (ANOVA) were used to detect compliance with CC guidelines and improvements in CC rate, depth, and recoil due to training with the Wii™. Before intervention with the Wii™, mean CC rate 113.17 CC/minute (95% confidence interval (CI) 108.36 to 117.98), mean CC depth 2.15 inches (95% CI 1.98 to 2.32), and mean CCs/minute without full chest recoil 7.50 CCs/minute (95% CI 3.79 to 11.21) were mostly outside recommended guidelines for optimal CCs. While receiving real-time visual feedback with the Wii™, mean CC rate 104.50 CCs/minute (95% CI 99.69 to 109.31), mean CC depth 1.82 inches (95% CI 1.66 to 1.99), and mean CCs/minute without full chest recoil 0.96 CCs/minute (95% CI 0.0 to 4.67) were significantly improved to within recommended guidelines. After subsequently removing visual feed back, mean CC rate 106.46 CCs/minute (95% CI 101.65 to 111.21), mean CC depth 1.80 inches (95% CI 1.63 to 1.97), and mean CCs/minute without full chest recoil 1.33 CCs/minute (95% CI 0.0 to 5.04) remained mostly within defined guidelines. Intervention with the Wii™ caused significant changes in CC rate (P=.023), depth (P=.017), and allowance of full chest wall recoil (P=.041). The effect on CC rate (P=.067), depth (P=.020), and chest recoil (P=.063) was partially maintained even after removal of visual feedback. During simulated CCs, the Nintendo Wii™ successfully improved the quality of CCs provided by emergency physicians to within recommended guidelines. Additional investigation is required to determine optimal length and frequency of training sessions needed to maintain competence in providing high quality CCs.