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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Every year there is some 50<span class="elsevierStyleHsp" style=""></span>000 out-of-hospital cardiorespiratory arrests &#40;OHCA&#41; in Spain that amount to up to 10&#37; of the total number of dead patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;2</span></a> One of today&#39;s challenges is to increase the rate of witnesses involved in OHCAs<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3&#8211;5</span></a> and improve the quality of cardiopulmonary resuscitation &#40;CPR&#41; since it often does not follow the actual recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As part of this effort to transform society and make it more CPR proactive and aware&#44; mobile technology&#44; the social media&#44; and digital platforms are contributing to learning and training in resuscitation protocols for especially young populations&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Smartphone mobile applications &#40;app&#41; are the leading platforms<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> for learning purposes and to find witnesses close to where the incident occurs&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> Also&#44; they can simulate the devices that provide feedback when performing chest compressions and ventilations<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11&#44;12</span></a> and they have been confirmed to improve the quality of the CPR&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Most of these apps use the information provided by the 3-axis accelerometer mounted on smartphones to translate these data into values of depth&#44; rhythm&#44; and number of compressions&#46; This means that the device needs to be hand-held while the CPR maneuvers are being performed&#46; However&#44; we do not know much about the interferences that can occur holding a smartphone while performing chest compressions&#46; We do not know much either about the app capacity to do the information follow-up or if it can impact the quality of the CPR&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The goal of this study was to assess the quality of app-guided CPR techniques performed by nonexperts with real time feedback&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Material and method</span><p id="par0030" class="elsevierStylePara elsevierViewall">A quasi-experimental cross-sectional study was conducted&#46; Randomization was performed intergroup &#40;the app that would be used was assigned&#41; and intragroup &#40;the order in which the tests would be run was assigned too&#41;&#46; The quality of the CPR was compared in 3 situations&#58; &#40;1&#41; CPR test without device &#91;T-CPR&#93;&#59; &#40;2&#41; CPR with a turned-off smartphone &#91;T-PHONE&#93;&#44; and &#40;3&#41; app-guided CPR randomizing 3 different apps &#91;T-APP&#93;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Sample</span><p id="par0035" class="elsevierStylePara elsevierViewall">A convenience sample of 113 first year nursing students was invited to participate in the study&#46; Inclusion criteria were that they knew how to use a smartphone and had no prior CPR training and&#47;or know-how&#46; Exclusion criteria were that they had prior CPR training or experience or physical disabilities limiting them from conducting this experiment&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All individuals were previously informed of the goals of the study and gave their written informed consent for their participation&#46; They were told that they would not be rewarded or penalized for their participation&#46; Results were anonymous through random coding&#46; This study observed all ethical principles established by the Declaration of Helsinki&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Since this was a sham study with manikins&#44; approval from the hospital ethics committee was not deemed necessary&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">App and smartphone</span><p id="par0050" class="elsevierStylePara elsevierViewall">The following apps are free of charge for IOS with feedback during the CPR and were used while conducting our research &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Pocket CPR&#174; &#40;Zoll Medical Corporation&#44; Chelmsford&#44; MA&#44; United States&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">It provides sound feedback with voice messages and visual information on the rhythm of compressions per minute and depth of the compressions performed&#44; metronome&#44; and measures for how long the CPR has been going&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">CPR Pro&#174; &#40;Ivor Medical&#44; Leeds&#44; United Kingdom&#41;&#46; It provides feedback on the rhythm of compressions per minute&#44; metronome and counts the number of compressions performed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Massage cardiaque et DSA&#174; &#40;MC et DSA&#41; &#40;Imaios&#44; Montpellier&#44; France&#41;&#46; It provides feedback on the depth and rhythm of compressions per minute&#44; counts the number of compressions performed&#44; metronome&#44; and measures for how long the CPR has been going&#46;</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">All apps were installed on an Iphone5S&#174; smartphone &#40;Apple Inc&#46;&#44; Cupertino&#44; CA&#44; United States&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Becoming familiar with the technique</span><p id="par0080" class="elsevierStylePara elsevierViewall">To avoid use bias and test the app more reliably&#44; participants were allowed to become familiar with the indications of the app with which they would be running the tests&#46; Also&#44; to spend time learning how they would hold the phone while performing the compressions&#46; Right when the test was about to start&#44; an instructor accredited by the CPR National Plan instructed the participants to &#8220;steadily compress the center of the chest&#8221;&#46; No participant performed any compressions on the manikin before running the tests&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">CPR test and manikin</span><p id="par0085" class="elsevierStylePara elsevierViewall">Each participant ran 3 hands-only CPR tests of 2-min duration each &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">CPR test without device &#91;T-CPR&#93;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">CPR test with a hand-held turned-off smartphone &#91;T-PHONE&#93;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">CPR test with a hand-held smartphone plus an active app to guide the chest compressions &#91;T-APP&#93;&#46;</p></li></ul></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">To avoid learning effect the order in which the tests would be run was randomized&#46; To minimize the effect of fatigue each CPR technique was performed with a 30-min timeframe separation&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The Laerdal Resusci Anne QCPR adult training manikin &#40;Stavanger&#44; Norway&#41; was used to perform the CPR measurements&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Variables</span><p id="par0115" class="elsevierStylePara elsevierViewall">Demographic data were gathered to characterize the sample&#46; Independent variables were average depth &#40;AD&#41; in mm&#59; average rhythm &#40;AR&#41; of compressions per minute&#59; percentage of compressions with proper hand placement &#40;PHP&#41;&#59; percentage of compressions with correct re-expansion &#40;CCR&#41;&#59; percentage of correct chest compression depth &#40;CCD&#41;&#59; percentage of compressions at correct rhythm &#40;CCR&#41;&#59; and overall quality &#40;QCPR&#41; according to the ERC guidelines of 2015&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> These variables were registered using the Laerdal Resusci Anne Wireless SkillReporter software version 2&#46;0&#46;0&#46;14 &#40;Stavanger&#44; Norway&#41;&#46; The Resusci Anne Wireless SkillReporter&#174; software provides a general parameter called quality of cardiopulmonary resuscitation &#40;QCPR&#41; based on the 4 variables of cardiac massage &#40;depth&#44; rhythm&#44; hand placement&#44; and re-expansion&#41;&#46; This is a widely used variable in studies with Laerdal simulators&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15&#8211;17</span></a> The result provided goes from 0&#37; to 100&#37;&#46; If the performance of the CPR deviates from the standard&#44; the score goes down&#46; The higher the deviation the lower the score&#46; In regard to the QCPR variable&#44; percentages &#62;70&#37; were considered quality CPR&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analysis</span><p id="par0120" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using IBM SPSS statistical software package version 20 &#40;SPSS&#44; Inc&#46;&#44; Chicago&#44; IL&#44; United States&#41;&#46; Results are expressed as central tendency measurements &#40;mean&#41; and dispersion &#40;typical deviation and confidence interval&#41;&#46; To verify the normality assumption of the sample the Kolmogorov&#8211;Smirnov test was used&#46; For the intragroup analysis&#44; the repeated measures ANOVA model with Bonferroni correction was used for variables with normal distribution&#46; The Friedman test was used for the variables that did not meet this criterion&#46; The Wilcoxon signed rank test was used for pair comparisons of cluster data&#46; <span class="elsevierStyleItalic">P</span> values &#60;&#46;05 were considered statistically significant&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Lastly&#44; the effect sizes &#40;ES&#41; in all pair comparisons were calculated&#46; Cohen test was used with variables with normal distribution and Rosenthal test with variables with non-normal distribution&#46; To describe the ES&#44; the parameters assigned by Cohen<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> and expanded by Rosenthal were used<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a>&#58; trivial &#40;&#60;0&#46;2&#41;&#44; small &#40;0&#46;2&#8211;0&#46;5&#41;&#44; medium &#40;0&#46;5&#8211;0&#46;8&#41;&#44; large &#40;0&#46;8&#8211;1&#46;3&#41; and very large &#40;&#62;1&#46;3&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">The overall sample &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>113&#41; included 82&#46;3&#37; women &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>93&#41; and 17&#46;7&#37; men &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; The mean age of female participants was 19&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2 years and the mean age of men was 18&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4 years&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Data regarding the CPR tests run are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Analyzing the absolute values according to the ERC recommendations<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; for the AD variable we found significantly lower values when using the CPR Pro and MC et DSA apps compared to the T-PHONE app with a small effect size &#40;0&#46;35 and 0&#46;45&#44; respectively&#41;&#46; The CPR Pro app also showed significantly lower values compared to the T-CPR app with a small effect size &#40;0&#46;34&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">When the AR value was analyzed&#44; the Pocket CPR and MC et DSA groups kept the mean AR within the ERC recommendations in the 3 tests run &#40;no significant differences were found&#41;&#46; However&#44; in the CPR Pro group where the T-CPR and T-PHONE apps did not follow the ERC recommendations&#44; significant differences were found when the T-APP was run &#40;0&#46;30 vs T-CPR and 0&#46;35 vs T-PHONE&#41; showing an average value within the recommendations &#40;113&#46;7 compressions per minute&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In the analysis of the CPR percent values &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; we saw that in the PHP&#44; CCR&#44; and CCD variables none of the apps used showed significant improvements or worsening compared to the T-CPR and T-PHONE apps &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Regarding the CR variable that shows the percentage of compressions at rhythms of between 100 and 120 compressions per minute&#44; significantly greater differences were seen when the T-APP was compared to the T-CPR&#46; These were the effect sizes of using the different apps&#58; Pocket CPR&#58; 0&#46;44&#59; CPR Pro&#58; 0&#46;35&#59; MC et DSA&#58; 0&#46;34&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Also&#44; in the Pocket CPR and CPR Pro apps significantly higher percentages were seen when compared to the T-PHONE test being the effect size 0&#46;53 in the first case and 0&#46;41 in the second&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">When we analyzed the overall quality of the CPR expressed in the QPCR variable&#44; the values obtained were always &#60;34&#37; in all the tests&#46; None of the apps showed statistically significant improvements and there was a significant reduction of quality when the MC et DSA app was compared to the T-PHONE test&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">Our study investigated the effectiveness of chest compressions by comparing 3 apps &#40;T-APP&#41;&#58; Pocket CPR&#174;&#44; CPR Pro&#174;&#44; and MC et DSA&#174; with CPR without device &#40;T-CPR&#41; and CPR with turned-off smartphone &#40;T-PHONE&#41;&#46; The study subjects did not improve their results with the app-guided CPR&#46; Actually&#44; in some cases the results were worse&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">This study is the result of numerous investigations conducted by inexperienced people and expert professionals healthcare providers on CPR techniques with feedback and improvement of resuscitation quality&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">12&#44;21&#8211;24</span></a> Several studies confirm that there are different devices available capable of providing feedback and improving the quality of chest compressions&#44; especially rhythm and depth when used by people trained in CPR techniques&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">25&#44;26</span></a> The students who participated in this research had no previous training and their first contact with CPR was to become familiar with the app before running the tests&#46; Inexperience with these platforms can be an important limiting factor as it happens in studies with lifeguards who ventilate better using mouth-to-mouth techniques than the resuscitative endovascular balloon<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> or studies on intubations that show better results in the absence of intubations&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a> Without proper knowledge&#44; training or experience the mechanisms designed to improve the CPR may just not work&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">CPR feedback devices should be used only if there is statistical proof of their validity and reliability as a measuring tool&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a> In this sense&#44; following the recommendations established by the US Food and Drug Administration<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> medical apps need to be regulated to guarantee their validity and reliability&#46; The apps used in our study did not improve the depth of compressions because resuscitators were inexperienced&#44; the app was not accurate enough or because performing CPR maneuvers while holding a smartphone is uncomfortable&#46; However&#44; there are other hands-free devices available today that can be an alternative&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Although there are several apps to practice resuscitation maneuvers&#44; not all stick to the recommendations established by scientific societies or have tested their precision and usability&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> For this reason&#44; the quality of resuscitation can vary depending on the feedback device used&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> In this sense&#44; the study conducted by Park et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a> assessed the use of the Pocket CPR app by placing the smartphone in 3 different positions &#40;hand-held&#44; with a hand-band&#44; and with an armband&#41;&#46; In any of the 3 cases&#44; the measurements of chest compression depth recorded were not valid for any of the 3 body locations and the error was attributed to the system providing the information&#58; the accelerometer&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In our study&#44; the apps managed to keep the frequency of compressions in significantly higher values compared to other tests&#46; We confirmed that the feedback device-guided CPR improved the rhythm of compressions&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">35&#44;36</span></a> However&#44; simple elements like LED devices or metronomes can improve this variable<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a> without having to keep the hands busy holding a mobile device&#46; Compression depth was insufficient in all the tests run even with the use of the apps&#46; Not reaching the necessary depth is a concurrent factor in numerous studies conducted with inexperienced people&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> Several causes can be the reason for this&#58; training&#44; experience or inaccurate feedback&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Mobile apps have revolutionized many aspects of CPR learning<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> or the activation of witnesses close to the incident prompting more CPR maneuvers being performed by the witnesses&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> However&#44; the use of apps as a support tool while performing quality CPR maneuvers still needs to be studied and complemented with more evidence&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Study limitations</span><p id="par0200" class="elsevierStylePara elsevierViewall">This sample included nursing students who&#44; although had no specific training&#44; may have had motivations that are different from other populations on the use of CPR&#46; This study used manikins and the results cannot be generalized to the routine clinical practice&#46; The results of the use of an app on a real victim or an actual scenario can generate different data&#46; All participants used the same smartphone&#44; which can also be a limiting factor&#44; since not all phones have the same size or the same performance&#59; therefore&#44; the findings should be interpreted with caution&#46; The lack of technical training on how to hold the smartphone or the inexperience of the subjects can be another limiting factor&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusion</span><p id="par0205" class="elsevierStylePara elsevierViewall">In light of the results of this sham study on the sample studied&#44; smartphone-mounted app-guided CPR techniques did not improve the results of compressions during resuscitation&#46; The only variable that improved using the apps was the percentage of compressions performed at a correct rhythm&#46; The average compression depth seems the most limiting factor to be able to make quality compressions regardless of the type of test or app used&#46; More studies are needed to learn more on the use of mobile apps as feedback providing tools when performing CPR maneuvers&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Funding</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declared that they did not receive any funding to conduct this study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Author contribution</span><p id="par0215" class="elsevierStylePara elsevierViewall">Felipe Fern&#225;ndez-M&#233;ndez&#58; study design and idea&#44; data mining&#44; analysis and interpretation of data&#59; paper draft&#44; and critical review&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Roberto Barcala-Furelos&#58; study design and idea&#44; analysis and interpretation of data&#44; and critical review&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Mart&#237;n Otero-Agra&#58; study design and idea&#44; data mining&#44; analysis and interpretation of data&#44; and critical review&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Mar&#237;a Fern&#225;ndez-M&#233;ndez&#58; study design and idea&#44; data mining&#44; analysis and interpretation of data&#44; and critical review&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Myriam Santos-Folgar&#58; study design and idea&#44; data mining&#44; analysis and interpretation of data&#44; and critical review&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Antonio Rodr&#237;guez-N&#250;&#241;ez&#58; study design and idea&#44; analysis and interpretation of data&#44; and critical review&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">All the authors approved the final version of this manuscript&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0250" class="elsevierStylePara elsevierViewall">Dr&#46; Roberto Barcala-Furelos has participated in the development of an educational CPR app &#40;CPR coach&#174;&#41; that was not tested or mentioned in this study&#46; The authors declared no conflicts of interest whatsoever&#46;</p></span></span>"
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              "identificador" => "sec0030"
              "titulo" => "CPR test and manikin"
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            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Variables"
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            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Statistical analysis"
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        6 => array:2 [
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          "titulo" => "Results"
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        7 => array:3 [
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          "titulo" => "Discussion"
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            0 => array:2 [
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              "titulo" => "Study limitations"
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          "titulo" => "Conclusion"
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        9 => array:2 [
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          "titulo" => "Funding"
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        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Author contribution"
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        11 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflicts of interest"
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        12 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-01-30"
    "fechaAceptado" => "2018-07-16"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1211533"
          "palabras" => array:6 [
            0 => "Cardiopulmonary resuscitation"
            1 => "Mobile phone applications"
            2 => "Smartphone"
            3 => "Learning"
            4 => "APP"
            5 => "Feedback"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1211532"
          "palabras" => array:6 [
            0 => "Reanimaci&#243;n cardiopulmonar"
            1 => "Aplicaciones m&#243;viles"
            2 => "Tel&#233;fono inteligente"
            3 => "Aprendizaje"
            4 => "APP"
            5 => "Retroalimentaci&#243;n"
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    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the quality of cardiopulmonary resuscitation &#40;CPR&#41; by lay people when guided by a mobile phone application with real-time feedback&#44; with the comparison of three different mobile phone applications &#40;APPs&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional quasi-experimental study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Participants</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A sample of 113 nursing students participated in the study&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Interventions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Three hands-only CPR tests with continuous compressions were performed&#58; &#40;i&#41; without external help&#59; &#40;ii&#41; with the mobile phone turned off&#59; and &#40;iii&#41; guided by APP&#46; Three different APPs were randomly assigned &#40;Pocket CPR&#174;&#44; CPR Pro&#174; and Massage cardiaque et DSA&#174;&#41;&#46; The mannequin Laerdal Resusci Anne QCPR &#40;Stavanger&#44; Norway&#41; 2&#46;0&#46;0&#46;14 software was used&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Variables of primary interest</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">APPs used&#46; Demographic variables characterizing the study sample&#46; Independent variables&#58; mean depth&#44; mean rate&#44; percentage of correct hand positioning&#44; percentage of compressions with correct re-expansion&#44; percentage of compressions with correct depth&#44; percentage of compressions at the correct rate&#44; and overall quality of CPR&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Overall CPR quality was 33&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;7&#37; using Pocket CPR&#44; 10&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;72&#37; using CPR Pro and 7&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;2&#37; using Massage cardiaque et DSA&#46; None of the APPs produced a statistically significant improvement&#46; The percentage of time that the resuscitator managed to maintain a correct compression rate improved when using all three APPs&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cardiopulmonary resuscitation guided by phone APPs did not improve the overall quality of compressions during resuscitation&#44; though it improved the percentage of compressions performed at the correct rate&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Participants"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Interventions"
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            "identificador" => "abst0025"
            "titulo" => "Variables of primary interest"
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            "identificador" => "abst0030"
            "titulo" => "Results"
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          6 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Evaluar la calidad de la reanimaci&#243;n cardiopulmonar &#40;RCP&#41; de personas no expertas guiada por una aplicaci&#243;n m&#243;vil con retroalimentaci&#243;n en tiempo real&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio cuasi-experimental de corte transversal&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Participantes</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Una muestra de 113 estudiantes de enfermer&#237;a sin experiencia ni formaci&#243;n en RCP participaron en el estudio&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Intervenciones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se realizaron tres test de RCP solo manos con compresiones continuas&#58; 1&#41; RCP sin dispositivo&#59; 2&#41; RCP con el tel&#233;fono apagado&#44; y 3&#41; RCP guiada por APP&#46; Se aleatorizaron tres aplicaciones diferentes &#40;Pocket CPR&#174;&#44; CPR Pro&#174; y Massage cardiaque et DSA&#174;&#41;&#46; Los tres test se realizaron de forma consecutiva&#44; aleatorizados y separados 30<span class="elsevierStyleHsp" style=""></span>min entre cada uno&#46; Se utiliz&#243; el maniqu&#237; Laerdal Resusci Anne QCPR &#40;Stavanger&#44; Noruega&#41; software 2&#46;0&#46;0&#46;14&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Variables de inter&#233;s principales</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Aplicaciones utilizadas&#46; Variables demogr&#225;ficas para caracterizar a la muestra&#46; Variables independientes&#58; media de profundidad&#44; ritmo medio&#44; porcentaje de posici&#243;n correcta de mano&#44; porcentaje de compresiones con reexpansi&#243;n correcta&#44; porcentaje de compresiones con profundidad correcta&#44; porcentaje de compresiones al ritmo correcto&#44; calidad global de la RCP&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La calidad global de la RCP fue del 33&#44;3&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#44;7 para Pocket CPR&#44; del 10&#44;9&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;72 para CPR Pro y del 7&#44;8&#37;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;2 para Massage cardiaque et DSA&#46; Con ninguna de las APP se consiguen mejor&#237;as estad&#237;sticamente significativas&#46; El porcentaje de tiempo que el reanimador consigui&#243; mantener el ritmo correcto mejor&#243; con el uso de las tres APP&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La RCP guiada por APP no mejor&#243; la calidad global de las compresiones durante la reanimaci&#243;n&#44; si bien mejor&#243; el porcentaje de compresiones realizadas a un ritmo correcto&#46;</p></span>"
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            "titulo" => "Dise&#241;o"
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            "titulo" => "Participantes"
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            "identificador" => "abst0055"
            "titulo" => "Intervenciones"
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            "identificador" => "abst0060"
            "titulo" => "Variables de inter&#233;s principales"
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            "titulo" => "Resultados"
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            "identificador" => "abst0070"
            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Fern&#225;ndez-M&#233;ndez F&#44; Barcala-Furelos R&#44; Otero-Agra M&#44; Fern&#225;ndez-M&#233;ndez M&#44; Santos-Folgar M&#44; Rodr&#237;guez-N&#250;&#241;ez A&#46; Evaluaci&#243;n sobre la t&#233;cnica de compresiones tor&#225;cicas usando APP&#46; &#191;Ayudan o entorpecen la reanimaci&#243;n cardiopulmonar&#63; Med Intensiva&#46; 2020&#59;44&#58;72&#8211;79&#46;</p>"
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Apps used&#58; Pocket CPR&#174;&#44; CPR Pro&#174;&#44; and Massage cardiaque et DSA&#174;&#46;</p>"
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Study chart&#46;</p>"
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      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparative chart of CPR percentages&#46;</p> <p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CCD&#44; correct chest compression depth&#59; CCR&#44; compressions with correct re-expansion&#44; in percentage&#59; CR&#44; correct rhythm during the test&#44; in percentage&#59; PHP&#44; compressions with proper hand placement&#44; in percentage&#59; QCPR&#44; quality CPR&#44; in percentage&#59; T-APP&#44; CPR test with a hand-held smartphone plus an active APP&#59; T-CPR&#44; CPR test without device&#59; T-PHONE&#44; CPR test with a hand-held turned-off smartphone&#46;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">AD&#44; average depth&#44; in millimeters&#59; AR&#44; average rhythm&#44; measured in compressions per minute&#59; NS&#44; non-significant&#59; TD&#44; typical deviation&#59; T-APP&#44; CPR test with a hand-held smartphone plus an active app&#59; T-CPR&#44; CPR test without device&#59; T-PHONE&#44; CPR test with a hand-held turned-off smartphone&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;TD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PHP</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;7 &#40;39&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;8 &#40;39&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pocket CPR<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;9 &#40;28&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;7 &#40;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;0 &#40;26&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPR Pro<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;8 &#40;33&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;9 &#40;39&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;7 &#40;30&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC et DSA<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;8 &#40;21&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CCR</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;6 &#40;33&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;7 &#40;37&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pocket CPR<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;3 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;4 &#40;35&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;9 &#40;36&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPR Pro<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;9 &#40;37&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;4 &#40;29&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;0 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MC et DSA<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;1 &#40;32&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CCD</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;8 &#40;26&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;5 &#40;28&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pocket CPR<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;8 &#40;29&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">CPR Pro<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPR Pro<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">MC et DSA<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;8 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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