Abstract / Summary
Significance/Background Survival from cardiac arrest depends on early, high-quality cardiopulmonary resuscitation (CPR), yet instructor-led basic life support (BLS) training is difficult to scale for frequent practice. Extended reality (XR), encompassing virtual reality (VR), augmented reality (AR), and mixed reality (MR), offers immersive, self-directed simulation that could reach more learners with less instructor time; however, whether XR achieves comparable skill-based competency remains unclear. Purpose This systematic review evaluated skill-based CPR competency using head-mounted VR, AR, and MR compared to traditional methods. Method Following PRISMA 2020 guidelines, CINAHL, PubMed, Scopus, and Web of Science were searched for full text, randomized controlled trials published in English between 2020 and 2025. Results Of 257 articles, 9 met inclusion criteria. Five studies reported no statistically significant difference between immersive technology and traditional CPR training, and one established non-inferiority. Among the remaining three studies, one reported significantly better performance with XR, one did not establish non-inferiority, and one found VR feasible and effective but inferior to traditional training for technical skills. Conclusion XR appears effective but not necessarily superior to traditional CPR training. Heterogeneity across studies underscores the need for standardization to validate these findings. Further research should evaluate skill retention and application within clinical practice. Implications for Practice XR offers medical-surgical nurses a repeatable, self-directed option for just-in-time BLS refreshers near the point of care, without scheduling instructor-led classes. Until combined programs are tested, XR is best positioned as an adjunct to traditional training, with attention to device cost, motion-sickness screening, and standardized learning objectives.