The use of serious games as an innovative educational strategy for learning cardiopulmonary resuscitation: an integrative review

Siqueira, Tainá Vilhar; Nascimento, Juliana da Silva Garcia; Oliveira, Jordana Luiza Gouvêa de; Regino, Daniela da Silva Garcia; Dalri, Maria Celia Barcellos

doi:10.1590/1983-1447.2020.20190293

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Integrative Review • Rev. Gaúcha Enferm. 41 • 2020 • https://doi.org/10.1590/1983-1447.2020.20190293 copy

The use of serious games as an innovative educational strategy for learning cardiopulmonary resuscitation: an integrative review

Uso del juego serio como una estrategia educativa innovadora para aprender la reanimación cardiopulmonar: revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the scientific evidence available in literature on the use of serious games for health students to learn about cardiopulmonary resuscitation.

Methods:

Integrative review in PubMed / MEDLINE®, LILACS, Scopus and CINAHL databases. Included primary studies, in Portuguese, English or Spanish, from January 2009 to August 2019. The Rayyan software was used for study selection.

Results:

We identified 115 studies, and 8 composed the sample, categorizing two domains: : Intention of the study with regard to cardiopulmonary resuscitation through the serious game, and method used by the serious game to teach CPR.

Conclusion:

Medical students are the main audience for serious game learning, and the main intentions of the games are to compare their effectiveness with traditional methodologies and knowledge retention. The method adopted is the description of a cardiorespiratory arrest for training. The serious game proved effective for learning cardiopulmonary resuscitation.

Keyword
Cardiopulmonary resuscitation; Students; Education; Video games

Study	Origin	Language	Level of evidence
Boada et al.2525. Boada I, Rodriguez-Benitez A, Garcia-Gonzalez JM, Olivet J, Carreras V, Sbert M. Using a serious game to complement CPR instruction in a nurse faculty. Comput Methods Programs Biomed. 2015;122(2):282-91. doi: https://doi.org/10.1016/j.cmpb.2015.08.006 https://doi.org/10.1016/j.cmpb.2015.08.0...	Spain	English	II
Creutzfeldt et al.2629. Creutzfeldt J, Hedman L, Felländer-Tsai L. Effects of pre-training using serious game technology on CPR performance--an exploratory quasi-experimental transfer study. Scand J Trauma Resusc Emerg Med. 2012;20:79. doi: https://doi.org/10.1186/1757-7241-20-79 https://doi.org/10.1186/1757-7241-20-79...	Escandinávia	English	III
Creutzfeldt et al.2727. Creutzfeldt J, Hedman L, Medin C, Heinrichs WL, Felländer-Tsai L. Exploring virtual worlds for scenario-based repeated team training of cardiopulmonary ressuscitation in medical students. J Med Internet Res. 2010;12(3):e38. doi: https://doi.org/10.2196/jmir.1426 https://doi.org/10.2196/jmir.1426...	Suécia	English	III
Buttussia et al.2828. Buttussi F, Pellis T, Cabas Vidani A, Pausler D, Carchietti E, Chittaro L. Evaluation of a 3D serious game for advanced life support retraining. Int J Med Inform. 2013;82(9):798-809. doi: https://doi.org/10.1016/j.ijmedinf.2013.05.007 https://doi.org/10.1016/j.ijmedinf.2013....	Italy	English	III
Cook et al.2929. Cook NF, McAloon T, O'Neill P, Beggs R. Impact of a web based interactive simulation game (PULSE) on nursing students' experience and performance in life support training: a pilot study. Nurse Educ Today. 2012;32(6):714-20. doi: https://doi.org/10.1016/j.nedt.2011.09.013 https://doi.org/10.1016/j.nedt.2011.09.0...	Inglaterra	English	II
Drummond et al.3030. Drummond D, Delval P, Abdenouri S, Truchot J, Ceccaldi PF, Plaisance P, et al. Serious game versus online course for pretraining medical students before a simulation-basedmastery learning course on cardiopulmonary resuscitation: a randomised controlled study. Eur J Anaesthesiol. 2017;34(12):836-44. doi: https://doi.org/10.1097/EJA.0000000000000675 https://doi.org/10.1097/EJA.000000000000...	France	English	II
Sena et al.3131. Sena DP, Fabrício DD, Silva VD, Bodanese LC, Franco AR. Comparative evaluation of video-based online course versus serious game for training medical students in cardiopulmonar resuscitation: a randomised trial. PloS One. 2019;14(4):e0214722. doi: https://doi.org/10.1371/journal.pone.0214722 https://doi.org/10.1371/journal.pone.021...	Brazil	English	II
Cutumisu et al.3232. Cutumisu M, Brown MRG, Fray C, Schmölzer GM. Growth mindset moderates the effect of the neonatal resuscitation program on performance in a computer-based game training simulation. Front Pediatr. 2018;6:195. doi: https://doi.org/10.3389/fped.2018.00195 https://doi.org/10.3389/fped.2018.00195 ...	Canadá	English	III

Study	Intentionality	Design	Effectiveness	Teaching-learning method
Boada et al.2525. Boada I, Rodriguez-Benitez A, Garcia-Gonzalez JM, Olivet J, Carreras V, Sbert M. Using a serious game to complement CPR instruction in a nurse faculty. Comput Methods Programs Biomed. 2015;122(2):282-91. doi: https://doi.org/10.1016/j.cmpb.2015.08.006 https://doi.org/10.1016/j.cmpb.2015.08.0...	Comparing the efficiency of the serious game LISSA and that of a traditional CPR teaching method.	Randomized clinical trial, carried out with 109 nursing students from a Spanish university. Three groups were taught by a classic teaching strategy and five used the LISSA. Target-audience: nurses	Students who used the LISSA had better scores for learning than those who used the traditional teaching method. The LISSA is effective for CPR.	An emergency situation (CPA) out of a hospital, in which the player has to save the victim through BLS using CPR. The player starts with 100 points and wrong decisions make this score drop.
Creutzfeldt et al.2629. Creutzfeldt J, Hedman L, Felländer-Tsai L. Effects of pre-training using serious game technology on CPR performance--an exploratory quasi-experimental transfer study. Scand J Trauma Resusc Emerg Med. 2012;20:79. doi: https://doi.org/10.1186/1757-7241-20-79 https://doi.org/10.1186/1757-7241-20-79...	Verifying whether medicine students trained through the serious game "Multiplayer Virtual World" can retain CPR knowledge and abilities.	Quasi-experimental study, with 30 medicine students separated in tree groups. Two groups (intervention) received a conventional CPR training and the serious game, while the other group only received a conventional training. Target-audience: physicians.	The intervention group retained more information regarding CPR than the control one. The serious game Multiplayer Virtual World CPR was effective.	Consists in four settings in which the subjects attend to a victim with PCA in an extra-hospital environment, using BLS.
Creutzfeldt et al.2727. Creutzfeldt J, Hedman L, Medin C, Heinrichs WL, Felländer-Tsai L. Exploring virtual worlds for scenario-based repeated team training of cardiopulmonary ressuscitation in medical students. J Med Internet Res. 2010;12(3):e38. doi: https://doi.org/10.2196/jmir.1426 https://doi.org/10.2196/jmir.1426...	To investigate the influence of the serious game Massively Multiplayer Virtual Worlds in the retention of CPR knowledge in medicine students.	Mixed-method study with 12 medicine students exposed to the CPR serious game. Target-audience: physicians.	Most subjects reported liking the training and approved it. However, it was found that they had trouble retaining the knowledge after six months.	The participants interact with the role of the victim and of the paramedics in 4 scenarios, using BLS.
Buttussia et al.2828. Buttussi F, Pellis T, Cabas Vidani A, Pausler D, Carchietti E, Chittaro L. Evaluation of a 3D serious game for advanced life support retraining. Int J Med Inform. 2013;82(9):798-809. doi: https://doi.org/10.1016/j.ijmedinf.2013.05.007 https://doi.org/10.1016/j.ijmedinf.2013....	To evaluate the efficacy of a serious game called Emergency Medical Services for the disAbled for the learning of ALS.	Quasi-experimental study for 40 ALS instructors, with two cardiac arrest scenarios and a test, which was applied immediately and three months later. Target-audience: professionals who participate in the ALS	There was a significant retention of knowledge. The game was considered effective for the retention of CPR knowledge and abilities.	The participants play as the leader of an ALS team, which must rescue a patient with CPA. The scenarios can be a living room or a train station, and the ALS must be used.
Cook et al.2929. Cook NF, McAloon T, O'Neill P, Beggs R. Impact of a web based interactive simulation game (PULSE) on nursing students' experience and performance in life support training: a pilot study. Nurse Educ Today. 2012;32(6):714-20. doi: https://doi.org/10.1016/j.nedt.2011.09.013 https://doi.org/10.1016/j.nedt.2011.09.0...	Evaluating the impact of a serious game called Plataforma para Graduação em Educação de Apoio à Vida (PULSE - Platform for Graduation in Life Support Education), involving the performance of nursing students for BLS.	Randomized clinical trial. Carried out with 34 nursing students divided in a control group (traditional BLS teaching) and an intervention group (game). Target-audience: nurses.	There was a statistically significant difference between the control group and the group exposed to the serious game. The PULSE is effective to develop abilities in CPR.	BLS scenarios, which gradually increase the difficulty level, and must be concluded within a specific time frame. There is an initial score, which decreases with each error.
Drummond et al.3030. Drummond D, Delval P, Abdenouri S, Truchot J, Ceccaldi PF, Plaisance P, et al. Serious game versus online course for pretraining medical students before a simulation-basedmastery learning course on cardiopulmonary resuscitation: a randomised controlled study. Eur J Anaesthesiol. 2017;34(12):836-44. doi: https://doi.org/10.1097/EJA.0000000000000675 https://doi.org/10.1097/EJA.000000000000...	To compare a traditional on-line course done through a lecture via PowerPoint to the serious game Staying Alive, in medicine students.	Experimental randomized trial with 82 medicine students using an on-line course (control group) and the serious game (intervention). Target-audience: physicians.	Regarding learning, there were no significant differences between the traditional method and the serious game.	In Staying Alive, the player enters in a medical office and finds a man undergoing CPA and, as a result, must apply BLS techniques.
Sena et al.3131. Sena DP, Fabrício DD, Silva VD, Bodanese LC, Franco AR. Comparative evaluation of video-based online course versus serious game for training medical students in cardiopulmonar resuscitation: a randomised trial. PloS One. 2019;14(4):e0214722. doi: https://doi.org/10.1371/journal.pone.0214722 https://doi.org/10.1371/journal.pone.021...	To compare the effects of a serious game for training CPR with a video on-line course, in medicine students.	Randomized clinical trial. 45 students were distributed in two groups. Group A watched a video lecture about the cardiac arrest in adults, while group B used the serious game. Target audience: physicians.	This serious game was as effective as the traditional teaching strategy used.	The game is developed in an environment outside the hospital, in which the player must identify a CPA victim and apply the BLS.
Cutumisu et al.3232. Cutumisu M, Brown MRG, Fray C, Schmölzer GM. Growth mindset moderates the effect of the neonatal resuscitation program on performance in a computer-based game training simulation. Front Pediatr. 2018;6:195. doi: https://doi.org/10.3389/fped.2018.00195 https://doi.org/10.3389/fped.2018.00195 ...	Examining the retention of knowledge about neonate CPR through the game RETAIN.	Quasi-experimental study, in which 50 health professionals in Canada used a serious game involving resuscitation scenarios. Target-audience: nurses, neonate nurses and physicians.	The serious game was related to an improvement regarding the development of critical actions during attention.	RETAIN takes place within a hospital, presenting scenarios for the advanced support of neonate life.

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[1] Corresponding author:
Tainá Vilhar Siqueira E-mail: taina_vilhar@hotmail.com