Life-saving Skills Research Articles

Exposure of the abdominal aorta and visceral branches for hemorrhage control: A 2020 EAST Master Class Video Presentation.

Rapid control of abdominal hemorrhage is a potentially life-saving surgical skill. Although open exposure and control of the abdominal aorta and its visceral branches is a fundamental part of surgical training, familiarity with the anatomy and spacial relationships of the surrounding structures can be challenging for even the experienced surgeon. Using a fresh perfused cadaver, this video provides a step by step visual guide for aortic exposure from the diaphragmatic hiatus to the iliac bifurcation. Key maneuvers including control of the supraceliac aorta, left medial visceral rotation with identification of superior mesenteric and celiac arteries, and exposure of the perirenal aorta and proximal renal vessels are outlined. Damage control and definitive management strategies are discussed and potential tips and pitfalls in addressing intraabdominal hemorrhage are highlighted. The critical application of aortic exposure for hemorrhage control is a life-saving intervention if done rapidly and effectively. This requires a sound understanding of aortic anatomy and necessary steps for adequate exposure and subsequent repair. This video outlines the necessary steps to perform these interventions.

Neonatal Intubation: Past, Present, and Future.

* Abbreviations: NEAR4NEOS: : National Emergency Airway Registry for Neonates 3D-CT: : 3-dimensional computed tomography Neonatal intubation is a lifesaving skill that has been performed by clinicians for over 200 years. Throughout history, the techniques used for neonatal intubation have improved and will continue to advance in the future. Although the incidence of neonatal intubation has decreased over time, the focus on neonatal intubation safety has increased. Current and future efforts to improve neonatal intubation success and safety are critical to improving neonatal outcomes. After completing this article, readers should be able to: 1. Summarize the history of neonatal intubation. 2. Recognize trends in the incidence of neonatal intubation. 3. Describe current and future efforts to improve neonatal intubation safety. Neonatal intubation is a lifesaving procedure. Neonatal intubation has been an essential skill in the practice of neonatology since the subspecialty was founded in the 1970s; however, the origins of neonatal intubation date back over 200 years. (1)(2)(3) Multiple advances have taken place in the practice of neonatal intubation since it was first described. Continued advances will undoubtedly take place in the future. Although the incidence of neonatal intubation has decreased over time, intubation remains a critical skill for neonatal clinicians. Current and future efforts focused on improving neonatal intubation safety are critical to improving neonatal outcomes. In this review, we examine the past, present, and future of neonatal intubation. ### The First Intubation Techniques The earliest accounts of neonatal resuscitation date back to the mid-1700s when Benjamin Pugh used a small tube made of coiled wire and covered in leather to ventilate the lungs of asphyxiated newborns. (2)(4) The Copenhagen obstetrician Paul Scheel published the first detailed description of neonatal tracheal intubation in 1798:“Having cleaned the throat, we come to the trachea itself. I believe it is best evacuated with a syringe attached to a long flexible tube, the diameter of which fits in the …

Inspiring Young Learners Toward a Career in Healthcare Using Simulation.

To inspire young learners toward a career in healthcare and provide them opportunities to learn lifesaving skills, a hospital-based simulation center collaborated with a local middle school to develop a 88-minute simulation-based educational activity. The activity consisted of eight 10-minute stations on lifesaving and basic medical skills. One hundred fifty students participated. Evaluation surveys showed students favored stations with extensive hands-on activities and valued the opportunity to interact with health professionals. Students also reported more interest in science careers after the visit. This collaborative effort is time-efficient and low-budget simulation-based learning experience that had an immediate impact on middle school students.

\u201cThe midwife helped me ... otherwise I could have died\u201d: women\u2019s experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman

BackgroundAfghanistan has one of the world’s highest maternal mortality ratios, with more than 60% of women having no access to a skilled birth attendant in some areas. The main challenges for childbearing Afghan women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, in accordance with the national plan for midwifery education.The aim of this study is to explore women’s experiences of professional midwifery care in four villages in Afghanistan covered by the project, so as to reveal challenges and improve services in rural and conflict-affected areas of the country.MethodsAn exploratory case-study approach was adopted. Fourteen in-depth interviews and four focus-group discussions were conducted. A total of 39 women participated – 25 who had given birth during the last six months, 11 mothers-in-law and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed using thematic content analysis.FindingsMany of the women greatly valued the trained midwives’ life-saving experience, skills and care, and the latter were important reasons for choosing to give birth in a clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence on the part of the midwives. Moreover, relatives’ disapproval, shame and problems with transport and security were important obstacles to women giving birth in the clinics.ConclusionsLocal recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilisation and satisfaction with maternal and neonatal health services in rural Afghanistan. Nevertheless, the quality of the services is still lacking, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritised.

Evaluation of I-Gel™ versus Classic LMA™ for Airway Management by Paramedics and Medical Students: A Manikin Study.

Background and Aim:Airway management is a lifesaving skill which all health-care workers should possess. Currently, most of the resuscitation councils recommend supraglottic airway devices as the technique of choice for airway management during cardiopulmonary resuscitation by health-care providers without expertise in tracheal intubation. This is because of its high first-pass success rate and easy to acquire and retain skill even by novices.Materials and Methods:The present study was planned to compare the efficacy of two commonly available supraglottic airway devices, classic LMA (cLMA) and I-gel in securing airway in adult manikin by inexperienced persons (58 paramedics and 46 medical students), after a brief training. Our primary aim was to determine the first attempt success rate, and other parameters studied were the time and ease of insertion, overall success rate, and preference for device.Results:The first-attempt success rate of I-gel was higher in both groups of participants (74% in students and 69% in paramedicals) compared to that of cLMA (70% in l students and 53% in paramedics) although the overall success was the same. Majority of participants could secure airway quickly and easily by I-gel than by cLMA. More than 90% of participants preferred I-gel over cLMA.Conclusion:This study shows that inexperienced persons could learn to place the I-Gel and cLMA successfully in the manikin after a brief training in manikin. The first-attempt success rate and insertion of I-gel was easier and faster than that of cLMA by both groups of participants and most participants preferred I-gel due to ease of handling.

Knowledge, Attitude, and Practice about CPR and Associated Factors among Laypersons in Dammam, Riyadh, and Jeddah

Background: Cardio-Pulmonary Resuscitation (CPR) is a crucial life-saving skill that should be taught to all members of the community. Objectives: To evaluate the knowledge, attitude, and practice about CPR and associated factors among laypersons. Materials and methods: A cross-sectional study that was done among layperson in Dammam, Riyadh, and Jeddah. Among 527 participants, 364 (69%) were male, and 163 (31%) were female. Most of our participants 472 (89.6%) did not receive CPR training while the remaining 55 (10.4%) received the CPR training. Results: Our results reveal that a significant correlation exists between education level and the CPR training received. The participants with a higher educational level are significantly higher among participants who received the training. Conclusions: Layperson CPR training rate in the study area (Dammam, Riyadh, and Jeddah) less common than in many developed countries.

The knowledge versus self-rated confidence of facility birth attendants with respect to maternal and newborn health skills: the experience of Nigerian primary healthcare facilities.

Competent and skilled birth attendants are critical in the reduction of maternal and infant morbidity and mortality at delivery. This study aimed to determine the association between knowledge and self-rated confidence in facility birth attendants affiliated with maternal and neonatal health (MNH) interventions. A descriptive cross-sectional study was conducted in 24 primary healthcare facilities in Osun state, Nigeria among 128 consenting facility birth attendants who were selected via a multi-stage sampling technique. Each attendant received a semi-structured interviewer-administered questionnaire. The dependent variables included the respondent's level of knowledge in MNH interventions and their self-rated confidence in MNH skills such as the provision of antenatal care service, normal labour, use of a partograph and the management of obstetric complications and post-partum haemorrhage. Bivariate analysis of factors associated with knowledge and self-rated confidence in MNH skills was performed with statistical significance set at p<0.05. Only 48 (37.5%) of the respondents had good knowledge of all of the assessed interventions; worse performances were reported with regards to the respondent's knowledge of normal labour and partograph use. However, 96 (75%) of respondents were confident in performing 75% of the skills assessed. Our analysis identified two factors that were significantly associated with a good knowledge of MNH skills: the cadre of the birth attendants (p<0.001) and training in life-saving skills (p=0.001). The knowledge of our respondents relating to most of the MNH interventions assessed was not significantly associated with their self-rated confidence in the required skills. The confidence of facility birth attendants in MNH skills was not knowledge-based and could frustrate national efforts to reduce maternal and perinatal deaths. We recommend effective and evidence-based training of all cadres of facility birth attendants to ensure that the skills being practiced clinically are based on adequate knowledge.

Process conformance is associated with successful first intubation attempt and lower odds of adverse events in a paediatric emergency setting

BackgroundIntubation is an essential, life-saving skill but associated with a high risk for adverse outcomes. Intubation protocols have been implemented to increase success and reduce complications, but the impact of...

Defining Competency in Neonatal and Pediatric Bag Mask Ventilation

Bag-mask ventilation (BMV) is a lifesaving skill required of neonatal and pediatric practitioners, including all those who hold NRP and PALS certification. As neonatal and pediatric practice evolves and further specializes, trainee exposure and opportunity to perform BMV has changed. There exists no standardized definition or measurement of competency in this procedure. Currently, performance in BMV is most often described by global assessment by an expert provider from which competency to perform BMV is inferred. As assessment …

Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand physiotherapists

Cardiopulmonary resuscitation (CPR) is an essential life-saving skill shown to save lives and improve outcomes of survivors. Physiotherapists are ethically obliged to ensure the safety of patients and to assist in an emergency if required. The purpose of this study was to explore the knowledge and perceptions of CPR amongst New Zealand physiotherapists. Chi-square statistics were used to test associations between the independent variables of age, sex, years of experience, scope and place of work, and postgraduate qualification against CPR training, beliefs and knowledge. A total of 688 physiotherapists completed the online survey. Only half of respondents (56%) had received formal CPR training in the previous year. One-fifth had used CPR in an emergency, with most applications being successful. Physiotherapists working in private practice, public hospitals and community settings were more likely to have CPR certification compared to other settings (p = 0.004). Significant CPR knowledge gaps existed in older (&gt; 39 years) physiotherapists (p &lt; 0.001). The current low frequency of CPR training and the likelihood of having to perform CPR in an emergency (1 in 5) is a risk for physiotherapists. Future research should focus on a practical assessment of physiotherapists’ CPR skills to assess competency.

Promotion of Cadaver-Based Military Trauma Education: Integration of Civilian and Military Trauma Systems.

For the past few decades, there has been an emphasis on encouraging the partnership of civilian and military trauma care systems which would allow military personnel to maintain competency in life-saving skills and gain experience prior to or in between deployments. Currently, there are only five primary military-civilian training centers in the United States. Thus, the majority of service members do not get the opportunity to train at these facilities prior to scheduled deployments. To bridge this gap, a joint military-civilian hands-on supplemental training program was established to allow deploying National Guard Combat Medics to practice life-saving techniques on human cadaver tissue. The purpose of this report is to provide the feedback survey from this pilot training session in hopes to expand and improve the curriculum and encourage partnerships between military and civilian trauma centers. Survey respondents include the 13 National Guard Combat Medic Specialists who attended the 6-hour voluntary training session. The survey asked qualitative and quantitative (using a 5-point Likert rating scale; 1 = insufficient/unacceptable/disagree; 5 = outstanding/exceeded expectations/strongly agree) questions regarding the structure of the session, likes and improvements about the classroom and cadaver lab portions, implementation into training, confidence in techniques before and after the session and overall rating of the session. This report has been reviewed and approved by the Institutional Review Board (IRB) at Rutgers University. Most attendees (12 of 13) agreed that the 6-hour total time length and division of classroom versus lab time was appropriate. Most attendees (12 of 13) agreed that this type of supplemental hands-on cadaver training should be a mandatory part of their medical training. The attendees' rated confidence in covered techniques was significantly increased from 3.77 ± 0.73 to 4.85 ± 0.38 (p < 0.01) before and after the session, respectively. The overall satisfaction rating of the session was 4.92 ± 0.28. This collaboration between military and civilian trauma care system was successful in giving National Guard combat medic specialists the opportunity to practice life-saving techniques on human tissue prior to deployment. This type of partnership can assist in maintaining readiness for trauma care and increasing the confidence of military pre-hospital providers in performing life-saving techniques.

Keeping Bystanders Active: Resuscitating Resuscitation Skills.

Introduction: Sufficient CPR skills in the general population are essential to make them active bystanders and contribute to an effective chain of survival in cardiac arrest emergencies. However, having a large proportion of the population regularly retrained is practically infeasible.Objective: The aim of this study was to assess and retrain cardiopulmonary resuscitation (CPR) skills of individuals who received (limited) CPR training several months to years prior.Method: Ninety-nine German adults in a possession of a driver's license were asked to perform CPR on a Laerdal Resusci Anne® QCPR manikin (Laerdal, Stavanger, Norway). After initial assessment, participants watched an instructional video and completed short, isolated compression, and ventilation practice with live feedback. CPR competency was assessed again after retraining and after a retention interval of 45 min.Results: Our results indicate that only 2% of participants managed to reach the performance criteria set by the European Resuscitation Council Guidelines, with most failing to reach even the lowest levels of performance. This corroborates earlier observations that CPR skills have deteriorated almost completely after a long retention interval, calling into question “one-and-done” certification of this basic life-saving. However, we also demonstrated that performance strikingly increased after watching a 6-min instructional video and a short opportunity for isolated practice. This increase in performance was stable over 45 min with 96% of participants meeting performance levels specified in the Guidelines. Closer inspection of the isolated compression practice data suggests that performance was very high at the start of the practice already, indicating that short refresher videos might suffice to change bystanders that would not have initiated CPR due to lack of knowledge into active first responders.Conclusion: We suggest that short refresher trainings could be an effective and affordable means of improving basic lifesaving skills to increase the effective contribution of bystanders during emergencies.

Establishing the first Hartford consensus-compliant medical school in the United States.

Following the Hartford Consensus meetings, the Stop the Bleed Campaign was created to reduce the prevalence of death from exsanguination in the case of traumatic hemorrhage. The campaign revolves around providing hemorrhage control training to members of the public and increasing public access to hemorrhage control equipment. To our knowledge, no medical school has established a self-sustaining Stop the Bleed program to train their students and faculty as well as made hemorrhage control equipment available for use in an emergency. Bleeding control classes were offered at the Frank H. Netter MD School of Medicine beginning in January 2018. A proposal was made to the medical school's Council on Curriculum Oversight in May 2018 to incorporate the training as part of the required curriculum for first-year students. A second proposal was made to Quinnipiac University's Emergency Management Team in June 2018 to purchase hemorrhage control equipment. Twelve bleeding control courses were held between January and August 2018. Two hundred ten medical students, 19 faculty members, and 36 public safety officers completed initial training. Thirty-four medical students, two faculty members, and two public safety officers became certified instructors. Training was incorporated into the first-year curriculum to be taught by certified second-year students under the direction of the school's Department of Surgery. The school purchased approved training equipment. A student-coordinator position was created in the Surgery Interest Group. Hemorrhage control equipment was purchased for each public safety officer, patrol vehicles, and for the Central Dispatch headquarters. Public-access equipment has been purchased for each Automated External Defibrillator cabinet at the medical school. The School of Medicine community has been empowered with the ability to save lives. Students and faculty have been trained in life-saving skills, a self-sustaining training process has been created, and equipment has been purchased for hemorrhage control efforts.

Empirical verification of self-rated positive health (somatic dimension) in women with professional competence in the field of health education

Purpose: to address a question whether reports of young women concerning their positive health are concordant with indices based on recommended methods of measuring health? Material: the study consist of fifteen, 23 years old female students of physiotherapy (height: QUOTE 15X"&gt; =164.3 ±4.55; weight: QUOTE 15X"&gt; = 60.7 ±6.76) who declared engagement in everyday or occasional physical activity. They completed The profile of the sense of positive health and survival abilities indices (SPHSA questionnaire). It includes 23 indices: 8 of somatic health (A), 4 of mental health (B), 3 of social health (C) and 8 of survival ability (D). The sense of intensity of particular indices (aspects A, B, C) is evaluated in the 1 to 5 scale where: 1 very low, 2 low, 3 average, 4 high, 5 very high. Additional index “0” (added to this five-point rating scale) is reserved to aspect D. Besides, SPHSA comprise 8 questions relating to subject’s earlier experiences associated with: safe falling, self-defence, martial arts, life-saving skills in the water, first aid, survival, uniformed services and scouting. Results: there is statistically significant correlation (r = 0.57; p&lt;0.05) between reported and diagnosed average value of general index of somatic health of young women. Reported and diagnosed values of general index of somatic health are concordant in 5 women (33% of study group). The remaining 10 women either overestimate (n = 7) or underestimate (n = 3) their somatic health. Regardless of declared physical activity women significantly overestimated their diastolic blood pressure and underestimate their anaerobic capacity and flexibility: p&lt;0.05 or p&lt;0.01 (these misestimations, concerns indices having extreme values, both highest and lowest). Tendency is more evident in case of everyday active women. Conclusions: results of the experiment allow recommendation SPHSA as a useful tool to measure people’s sense of somatic health. Concurrently person’s self-evaluations can be easily verified because they concern such characteristics of the body which can be measured by quasi-objective methods (criterion validity).

\u201cPractice so that the skill does not disappear\u201d: mixed methods evaluation of simulator-based learning for midwives in Uganda

BackgroundPostpartum hemorrhage and neonatal asphyxia are leading causes of maternal and neonatal mortality, respectively, that occur relatively rarely in low-volume health facilities in sub-Saharan Africa. Rare occurrence of cases may limit the readiness and skills that individual birth attendants have to address complications. Evidence suggests that simulator-based training and practice sessions can help birth attendants maintain these life-saving skills; one approach is called “low-dose, high-frequency” (LDHF). The objective of this evaluation is to determine the facilitating factors and barriers to participation in LDHF practice, using qualitative and quantitative information.MethodsA trial in 125 facilities in Uganda compared three strategies of support for LDHF practice to improve retention of skills in prevention and treatment of postpartum hemorrhage and neonatal asphyxia. Birth attendants kept written logs of their simulator-based practice sessions, which were entered into a database, then analyzed using Stata to compare frequency of practice by the study arm. The evaluation also included 29 in-depth interviews and 19 focus group discussions with birth attendants and district trainers. Transcripts were entered in Atlas.ti software for coding, then analyzed using content analysis to identify factors that motivated or discouraged simulator-based practice.ResultsPractice log data indicated that simulator-based practice sessions occurred more frequently in facilities where one or two practice coordinators helped schedule and lead the practice sessions and in health centers compared to hospitals. The qualitative data suggest that birth attendants who practiced more were motivated by a desire to maintain skills and be prepared for emergencies, external recognition, and establishing a set schedule. Barriers to consistent practice included low staffing levels, heavy workloads, and a sense that competency can be maintained through routine clinical care alone. Some facilities described norms around continuing education and some did not.ConclusionsDesignating practice coordinators to lead their peers in simulator-based practice led to more consistent skills practice within frontline health facilities. Ongoing support, scheduling of practice sessions, and assessment and communication of motivation factors may help sustain LDHF practice and similar forms of continuing professional development.Trial registrationRegistered with clinicaltrials.gov #NCT03254628 on August 18, 2018 (registered retrospectively).

All schoolchildren to learn life-saving skills from 2020

All schoolchildren to learn life-saving skills from 2020

Utilization of Life-Saving Skills Among Nurses and Midwives at Murtala Muhammad Specialist Hospital, Kano

Maternal morbidity and mortality associated with pregnancy and childbirth have a significant impact on women, their families, and communities in low-income countries. This study aimed at exploring the level of awareness on Life-Saving Skills (LSS), LSS practices employed, barriers to implementation, and strategies to promote effectiveness of LSS practice. The study utilized a cross-sectional research design and a pre-tested structured interviewer-administered questionnaire to survey 154 nurses and midwives in a hospital in Nigeria with 150 maternity beds, about their “awareness” of LSS, LSS practices, and what they consider barriers to implementation and strategies to promote effectiveness of LSS practice. Results demonstrated that while 87.0% of the respondents were aware of LSS, the majority reported numerous challenges in implementing LSS. These challenges included: a shortage of skilled birth attendants (93.5%); negative attitudes of healthcare providers (79.2%); inadequate equipment and supplies (81.8%); and inadequate training for midwives (77.9%). Respondents also recommended some strategies to promote effectiveness of LSS, including provision of life-saving skills equipment (84.4%); training and retraining of personnel in LSS (88.3%); and increasing accessibility of LSS services for childbearing women (97.4%). The study concluded that although there is a high level of awareness of LSS, the midwives and nurses faced many challenges that hindered the utilization of LSS. It is recommended that multilateral collaboration be used in the study setting to overcome the limitations to utilize LSS.

Complications Associated With Placement of Chest Tubes: A Trauma System Perspective

BackgroundThe insertion of a chest tube is a common procedure in trauma care, and the Advanced Trauma Life Support program teaches the insertion of chest tubes as an essential and life-saving skill. It is also recognized that the insertion of chest tubes is not without risks or complications. The purpose of this study was to evaluate complications of chest tube placement in a level 1 trauma center compared with those placed in surrounding referral hospitals. MethodsA retrospective matched cohort study of trauma patients was performed between those who underwent chest tube placement at the level 1 trauma center and those with a chest tube placed before transfer to the level 1 center between 2004 and 2013. Conditional logistic regression was used to compare the likelihood of complications and death between chest tube placement groups. ResultsFour thousand two hundred and sixteen trauma patients had a chest tube placed at the level 1 center, and 364 patients had a chest tube placed at an outside hospital before transfer. Two hundred and eighty-one patients were matched. Patients with a chest tube placed outside the trauma center had an increased likelihood of malposition (OR 7.2, 95% CI 3.6-14.6), residual hemothorax (OR 6.3, 95% CI 3.4-11.6), residual pneumothorax (OR 6.7, 95% CI 3.9-11.4), and having a second chest tube placed (OR 3.77, 95% CI 2.37-6.01). However, the patients with a chest tube placed outside of the trauma center were also less likely to develop pneumonia (OR 0.32, 95% CI 0.14-0.73). There were no differences in the odds of developing an empyema, the need for video-assisted thoracoscopic surgery, thoracotomy, or death. ConclusionsThere are opportunities for improving the care of patients who require chest tubes at both referring hospitals and the receiving trauma center. Improving the care of patients who require intercostal drainage requires a systems-based approach, focusing on training and quality improvement.

World trauma education: hemorrhage control training for healthcare providers in India

BackgroundHemorrhage remains a major cause of death around the world. Eighty percent of trauma patients in India do not receive medical care within the first hour. The etiology of these...

Virtual Reality Simulation Technology for Cardiopulmonary Resuscitation Training: An Innovative Hybrid System With Haptic Feedback

Objective. Although cardiopulmonary resuscitation (CPR) skills are lifesaving skills, the gap between awareness and actual training remains significant. Advances in technology are shaping the future of education and innovative learning solutions are essential to facilitate effective and accessible training. This project objective is to develop a self-directed educational system for hands-on CPR training using virtual reality (VR) technology. Methods. HTC VIVE was the chosen VR engine, and Unity3D was the software used for development. CPR skills including chest compressions, rescue breathing, and automated external defibrillator (AED) are taught in VR through focused instructions, demonstrations, and simulated interactive scenarios with hands-on training sessions. A tracking system was designed using virtual planes and VIVE-Tracker for accurate measurements of chest compressions (rate, depth, and recoil), hands’ position and AED. A real mannequin was integrated in the VR space and overlaid with virtual 3D-human model for realistic haptic feedback and hands-on training. VIVE-controller was used for precise calibration between the mannequin location in real environment and the virtual human model in VR space. Results. The VR-CPR prototype was designed to be generic, approachable, and easy to follow. Realism and interaction were achieved through 3D virtual scenes simulating common sites at which cardiac arrest may occur. Variety in scenarios and gamification features like scoring and difficulty levels of training were made to enhance users’ engagement. The VR-mannequin hybrid system enabled quality training and immersive learning experience. Further, real-time feedback and scoring system are built for self-directed learning and optimal performance. Conclusions. The developed VR-hybrid product is a structured educational tool for hands-on CPR training and ongoing practice. This innovative technology provides self-directed learning with no restrictions of time, place, or personnel, which are the main challenges with current traditional courses. This product is a promising CPR training initiative in the evolution of digital education.