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Rationale and design of the Lowlands Saves Lives trial: a randomised trial to compare CPR quality and long-term attitude towards CPR performance between face-to-face and virtual reality training with the Lifesaver VR app
  1. Joris Nas1,
  2. Jos Thannhauser1,
  3. Priya Vart2,
  4. Robert-Jan van Geuns1,
  5. Niels van Royen1,
  6. Judith L Bonnes1,
  7. Marc A Brouwer1
  1. 1Cardiology, Radboudumc, Nijmegen, The Netherlands
  2. 2Health Evidence, Radboudumc, Nijmegen, The Netherlands
  1. Correspondence to Joris Nas; j.nas{at}


Introduction Layperson cardiopulmonary resuscitation (CPR) is a key aspect in the chain of survival after cardiac arrest. New, low-cost, easily accessible training methods such as virtual reality (VR) training with a smartphone application may reach broader populations, but data on CPR performance are scarce.

Methods and analysis The Lowlands Saves Lives trial is a prospective randomised open-blinded end-point evaluation study, comparing two 20 min CPR training protocols: standardised, certified instructor-led face-to-face training complying with current education guidelines (using Laerdal Little Anne manikins), and VR training, using the UK Resuscitation Council endorsed Lifesaver VR app. In the latter, chest compressions are practiced on a pillow.

During VR training, participants learn to resuscitate by completing a filmed CPR scenario while wearing VR goggles and headphones. Eligible for inclusion are adult attendees of Lowlands Science, a specific section of the 3-day Lowlands music festival (50 000 attendees), dedicated exclusively to science. Following the training, all participants will perform a CPR test on a Laerdal Resusci Anne QCPR manikin. Primary outcome measures are depth and rate of chest compressions, measured using CPR manikins. The key secondary outcome is overall CPR performance, with real-time examination (blinded for study group) of all items of a European Resuscitation Council endorsed checklist, and evaluation of a sample of videotaped CPR tests by a blinded event committee.

Given the unique setting of a festival, the primary additional analysis will address the impact of alcohol levels on CPR quality parameters and overall performance. Follow-up questionnaires will evaluate the attitude towards performing CPR. This unique study may provide important insights into innovative CPR training methods, factors that impact CPR performance and the impact on long-term attitude towards resuscitation.

Ethics and dissemination This study received approval from the research ethics committee of the Radboudumc. All participants will provide written informed consent. The results of this study will be published in peer-reviewed journals and presented at (inter)national conferences.

Trial registration number registry (NCT04013633).

  • cardiac arrest
  • cardiopulmonary resuscitation
  • virtual reality
  • basic life support
  • education

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  • Collaborators Scientific committee: Lars Wik MD PhD (Oslo University Hospital, Oslo, Norway) and Giuseppe Ristagno MD PhD (Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy). Event committee: Reinier Waalewijn MD PhD (National course director advanced life support, Gelre Hospital, Apeldoorn, the Netherlands) and Wiebe de Vries PhD (University of Applied Sciences Leiden, Leiden, The Netherlands).

  • Contributors JN, JT, JLB and MAB conceived the idea. JN, JT, RvG, NvR, JLB and MAB designed the study methodology. JN, PV and MAB designed the statistical analyses. JN, JT, JLB and MAB drafted the manuscript. PV, RvG and NvR provided critical revisions and substantial intellectual input. All authors agreed with the final version of the manuscript. JN takes full responsibility for integrity of the presented content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Patient consent for publication Not required.

  • Ethics approval The study will be conducted according to the principles of the Declaration of Helsinki and in accordance with the Medical Research Involving Human Subjects act. The research ethics committee of the Radboud University Medical Center has reviewed this study on the basis of the Dutch Code of conduct for health research, the Dutch Code of conduct for responsible use, the Dutch Personal Data Protection Act and the Medical Treatment Agreement Act. The ethics committee has passed a positive judgement on the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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