Simulação de alta fidelidade no ensino da ressuscitação cardiopulmonar: comparação entre realidade virtual e manequim simulador - revisão sistemática com meta-análise

Abstract

Cardiopulmonary arrest remains the greatest challenge in the field of urgency and emergency care, in which the quality of cardiopulmonary resuscitation maneuvers is the primary determinant for survival and neurological prognosis. The training of healthcare professionals requires methodologies that ensure technical proficiency and skill retention. In this context, high-fidelity simulation stands out as the standard of excellence, constituting the pedagogical basis for different teaching modalities, such as virtual reality and high-fidelity manikins. While the high-fidelity manikin is traditionally considered the main reference in teaching, virtual reality presents itself as an emerging and potentially scalable technological alternative. In this sense, this study aimed to evaluate the efficacy of high-fidelity virtual reality simulation training, compared to high-fidelity manikin simulation training, in the acquisition and retention of knowledge and practical performance of healthcare professionals and students, aiming for proficiency in cardiopulmonary resuscitation. To this end, a systematic review with meta- analysis was conducted, based on the Healthcare Simulation Standards of Best Practice of the International Nursing Association for Clinical Simulation and Learning. The search was conducted in May 2025 in the Cochrane Library, PubMed, Web of Science, ScienceDirect, Scopus, LILACS, and Embase databases. The “Population, Intervention, Control, Outcome” (PICO) strategy was adopted for the elaboration of the research question. Only randomized controlled trials that compared virtual reality to the high-fidelity manikin in the context of cardiopulmonary resuscitation were included. The selection of studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, performed by two independent reviewers, in a blinded manner, on the Rayyan platform, and the study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform. The risk of bias was assessed by the Risk of Bias Tool (RoB 2.0) and the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Quantitative synthesis was performed by random-effects meta-analysis, using the standardized mean difference for continuous outcomes. To obtain the results, seven randomized clinical trials were included, totaling 470 participants, with a mean age between 20 and 23 years and a higher concentration of publications in Turkey. The meta-analysis demonstrated statistical equivalence between virtual reality and the high-fidelity manikin both in the acquisition of theoretical knowledge and in the performance of practical cardiopulmonary resuscitation skills. Virtual reality stood out for its high immersion and user satisfaction, while the high-fidelity manikin offered the advantage of tactile feedback. The certainty of the evidence was classified as very low by GRADE, due to the heterogeneity of the studies and the nature of the interventions. It was identified that the long-term sustainability of skills remains a theoretical gap, requiring future longitudinal studies. Thus, it is evident that virtual reality simulation proves to be a viable, effective, and highly immersive modality for cardiopulmonary resuscitation training, presenting learning outcomes equivalent to the high-fidelity manikin. However, the physical and haptic response of the manikin remains a relevant differentiator for the refinement of specific psychomotor skills. It is concluded that such modalities are not mutually exclusive, but complementary, and their integration should be guided by the International Nursing Association for Clinical Simulation and Learning standards to strengthen permanent health education. Finally, the need for future longitudinal research focusing on learning retention and the long-term impact of training is emphasized, in order to establish clear skill recycling intervals and consolidate the role of simulation technologies as strategic tools in healthcare education.