[Blended learning versus virtual reality and traditional methods in cardiopulmonary resuscitation training: a randomized trial in university students].

Objective
Out-of-hospital cardiac arrest is the leading cause of sudden death. Basic Life Support (BLS) training is an essential competency in Nursing. Active learning methodologies such as blended learning may improve educational outcomes.Design
A randomized controlled trial with four parallel groups (n=160).Participants
was conducted among first-year undergraduate nursing students. Site: At a university in the Region of Murcia, Spain.Interventions
Four methodologies were compared: traditional training, virtual reality (VR), blended learning, and a control group with no intervention. Practical competence was assessed using an 8-item checklist covering key steps in the chain of survival. Technical parameters were measured using Laerdal QCPR® manikins, including percentage of high-quality CPR, compression depth, rate, and full chest recoil. ANOVA, chi-square tests, and correlation models were applied (p<0.05).Results
Practical competence differed significantly between groups (p<0.001).Main Measurements
The blended and traditional groups achieved the highest scores (6.6±1.7 and 6.6±1.5, respectively), followed by the VR group (6.3±1.5) and the control group (3.1±1.5). Mean CPR quality also differed significantly (p=0.0045), with the blended group showing the highest percentage (72.3%), followed by traditional (65.4%), VR (63.4%), and control (46.9%). Regarding compression depth (p=0.0011), the blended and VR groups achieved similar results (6.1cm), outperforming the traditional (5.5cm) and control (4.8cm) groups. Perceived usability of the VR system was high (78/100).Conclusions
Blended learning showed overall better performance in most variables analyzed, with higher CPR quality and equal or superior results in practical competence and compression depth compared to the traditional and immersive models. These findings support its effectiveness as a teaching strategy for acquiring BLS competencies.