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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Se estima que en Espa&#241;a se producen anualmente unas 50&#46;000 paradas cardiorrespiratorias &#40;PCR&#41; a nivel extrahospitalario que originan hasta el 10&#37; del n&#250;mero total de fallecidos<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Uno de los retos actuales es aumentar la tasa de testigos que intervienen en la parada cardiaca extrahospitalaria &#40;PCEH&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">3-5</span></a> y mejorar la calidad de la reanimaci&#243;n cardiopulmonar &#40;RCP&#41;&#44; pues con frecuencia no cumple con las recomendaciones actuales<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En este esfuerzo por transformar la sociedad hacia una conciencia proactiva hacia la RCP&#44; la tecnolog&#237;a m&#243;vil&#44; las redes sociales y los soportes digitales est&#225;n contribuyendo al aprendizaje y entrenamiento en resucitaci&#243;n de la poblaci&#243;n especialmente joven<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las aplicaciones m&#243;viles para tel&#233;fonos inteligentes &#40;APP&#41; se han posicionado como plataformas para el aprendizaje<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a>&#44; para la localizaci&#243;n de testigos pr&#243;ximos al incidente<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a>&#44; y tambi&#233;n han pretendido simular a los dispositivos que proveen feedback en la realizaci&#243;n de las compresiones tor&#225;cicas y ventilaciones<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; ya que estos han demostrado una mejora en la calidad de la RCP<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Gran parte de estas APP utilizan la informaci&#243;n del aceler&#243;metro en los diferentes ejes para traducir esos datos en los valores de profundidad&#44; ritmo y n&#250;mero de compresiones&#44; por lo que se necesita mantener el dispositivo en contacto con las manos durante las RCP&#46; Sin embargo&#44; poco se sabe de las interferencias que pueda suponer realizar compresiones tor&#225;cicas con un tel&#233;fono m&#243;vil en las manos o de la capacidad de seguimiento de la informaci&#243;n de la APP y si esto puede influir en la calidad de la RCP&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo de este estudio ha sido evaluar la calidad de la RCP de personas no expertas guiada por aplicaci&#243;n m&#243;vil &#40;APP&#41; con retroalimentaci&#243;n en tiempo real&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Material y m&#233;todo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio cuasi-experimental de corte transversal&#46; La aleatorizaci&#243;n se llev&#243; a cabo de manera intergrupal &#40;asignar la APP a utilizar&#41; e intragrupo &#40;asignar el orden de los test&#41;&#46; Se compar&#243; la calidad de la RCP en tres situaciones&#58; 1&#41;<span class="elsevierStyleHsp" style=""></span>RCP sin dispositivo &#91;T-RCP&#93;&#59; 2&#41;<span class="elsevierStyleHsp" style=""></span>RCP con el tel&#233;fono apagado &#91;T-PHONE&#93;&#44; y 3&#41;<span class="elsevierStyleHsp" style=""></span>RCP guiada por APP aleatorizando tres aplicaciones diferentes &#91;T-APP&#93;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Muestra</span><p id="par0035" class="elsevierStylePara elsevierViewall">Una muestra de conveniencia de 113 estudiantes de primer curso del grado de enfermer&#237;a fue invitada a participar en este estudio&#46; Los criterios de inclusi&#243;n fueron que usasen de forma habitual un Smartphone y que no tuviesen formaci&#243;n y&#47;o conocimientos de RCP&#46; Los criterios de exclusi&#243;n fueron que tuviesen formaci&#243;n o experiencia en RCP o cualquier impedimento f&#237;sico que les limitase para realizar el experimento&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Todos los sujetos fueron informados por escrito de los objetivos del estudio y otorgaron su consentimiento informado&#46; Se les indic&#243; que no ser&#237;an ni recompensados ni perjudicados por participar&#46; Los resultados fueron anonimizados mediante c&#243;digo aleatorio&#46; Esta investigaci&#243;n respet&#243; los principios &#233;ticos de la declaraci&#243;n de Helsinki&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Por tratarse de un estudio de simulaci&#243;n con maniqu&#237;s no fue necesaria la aprobaci&#243;n por el Comit&#233; de &#201;tica&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">APP y Smartphone</span><p id="par0050" class="elsevierStylePara elsevierViewall">Las siguientes APP gratuitas para IOS con feedback durante la RCP fueron usadas en esta investigaci&#243;n&#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 Coporation&#44; Chelmsford&#44; MA&#44; EE&#46;UU&#46;&#41;&#46; Ofrece retroalimentaci&#243;n sonora con mensajes de voz&#44; informaci&#243;n visual con ritmo de compresiones por minuto y profundidad de las compresiones&#44; metr&#243;nomo y mide el tiempo de RCP&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b&#41;</span><p id="par0060" class="elsevierStylePara elsevierViewall">CPR Pro&#174; &#40;Ivor Medical&#44; Leeds&#44; Reino Unido&#41;&#46; Ofrece feedback del ritmo de compresiones por minuto&#44; metr&#243;nomo y cuenta el n&#250;mero de compresiones&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Massage cardiaque et DSA&#174; &#40;MC et DSA&#41; &#40;Imaios&#44; Montpellier&#44; Francia&#41;&#46; Ofrece feedback de profundidad y ritmo de compresiones por minuto&#44; cuenta el n&#250;mero de compresiones&#44; metr&#243;nomo y mide el tiempo de RCP&#46;</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Todas la aplicaciones fueron instaladas en un tel&#233;fono Iphone5S&#174; &#40;Apple Inc&#44; Cupertino&#44; CA&#44; EE&#46;UU&#46;&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Familiarizaci&#243;n t&#233;cnica</span><p id="par0075" class="elsevierStylePara elsevierViewall">Para no incurrir en un sesgo de uso y poder testar la aplicaci&#243;n con mayor fiabilidad&#44; se realiz&#243; una fase de familiarizaci&#243;n con las indicaciones de la APP con la que realizar&#237;an la prueba y con la forma de sujetar el tel&#233;fono durante las compresiones&#46; En el momento en el que se iba a iniciar el test un instructor acreditado por el Plan Nacional de RCP indic&#243; a los sujetos &#171;debe comprimir en el centro del pecho de forma ininterrumpida&#187;&#46; Ning&#250;n participante realiz&#243; compresiones sobre el maniqu&#237; antes de los diferentes test&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Test de RCP y maniqu&#237;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cada participante realiz&#243; tres test de RCP solo manos de dos minutos de duraci&#243;n cada uno&#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="par0085" class="elsevierStylePara elsevierViewall">Test de RCP sin dispositivo &#91;T-RCP&#93;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Test de RCP con el tel&#233;fono enlazado entre las manos pero apagado &#91;T-PHONE&#93;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Test de RCP con tel&#233;fono enlazado entre las manos con APP activa guiando las compresiones tor&#225;cicas &#91;T-APP&#93;&#46;</p></li></ul></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Para evitar el efecto del aprendizaje se aleatoriz&#243; el orden de los test&#44; y para minimizar el efecto de la fatiga&#44; cada RCP fue distanciada 30<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">El maniqu&#237; usado para la medici&#243;n de la RCP ha sido Laerdal Resusci Anne QCPR &#40;Stavanger&#44; Noruega&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Variables</span><p id="par0110" class="elsevierStylePara elsevierViewall">Se recogieron los datos demogr&#225;ficos para caracterizar a la muestra&#46; Las variables independientes fueron la media de profundidad en mm &#40;MP&#41;&#44; el ritmo medio de compresiones por minuto &#40;RM&#41;&#44; el porcentaje de posici&#243;n correcta de manos &#40;CPM&#41;&#44; el porcentaje de compresiones con reexpansi&#243;n correcta &#40;CRC&#41;&#44; el porcentaje de compresiones con profundidad correcta &#40;CPC&#41;&#44; el porcentaje de compresiones al ritmo correcto &#40;RC&#41; y la calidad global &#40;QRCP&#41; de acuerdo a las gu&#237;as ERC 2015<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a>&#46; Estas variables fueron recogidas con el software Laerdal Resusci Anne Wireless SkillReporter versi&#243;n 2&#46;0&#46;0&#46;14 &#40;Stavanger&#44; Noruega&#41;&#46; El software Resusci Anne Wireless SkillReporter&#174; proporciona un par&#225;metro general&#44; denominado calidad de la reanimaci&#243;n &#40;QRCP&#41;&#44; calculado en base a cuatro variables del masaje cardiaco &#40;profundidad&#44; ritmo&#44; posici&#243;n de manos y reexpansi&#243;n&#41;&#46; Esta es una variable de uso muy frecuente en la investigaci&#243;n con simuladores Laerdal<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15-17</span></a>&#46; El resultado proporcionado va del 0 al 100&#37;&#46; Si el rendimiento de RCP se desv&#237;a del est&#225;ndar&#44; la puntuaci&#243;n se reduce&#46; Cuanto mayor es la desviaci&#243;n&#44; m&#225;s se reduce la puntuaci&#243;n&#46; Para la variable QRCP se acept&#243; como RCP de calidad la que superara el 70&#37;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">An&#225;lisis estad&#237;stico</span><p id="par0115" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con el software IBM SPSS Statistics versi&#243;n 20 &#40;SPSS&#44; INC&#44; Chicago&#44; Illinois&#44; EE&#46;UU&#46;&#41;&#46; Los resultados son presentados en medidas de tendencia central &#40;media&#41; y de dispersi&#243;n &#40;desviaci&#243;n t&#237;pica e intervalo de confianza&#41;&#46; Para comprobar la normalidad de la muestra se realiz&#243; el test de Kolmogorov-Smirnov&#46; Para el an&#225;lisis intragrupo se us&#243; un ANOVA de medidas repetidas con correcci&#243;n de Bonferroni para las variables con distribuci&#243;n normal&#44; y el test de Friedman para las que no cumpl&#237;an este supuesto&#46; Para realizar la comparaci&#243;n por pares en estas variables se utiliz&#243; el test de suma de rangos de Wilcoxon&#46; Se estableci&#243; un nivel de significaci&#243;n &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; se comprob&#243; el tama&#241;o del efecto en todas las comparaciones por pares&#46; Para ello se utiliz&#243; el test de Cohen para las variables con distribuci&#243;n normal y el test de Rosenthal para las variables con distribuci&#243;n no normal&#46; Para describir el tama&#241;o del efecto &#40;ES&#41; se siguieron los par&#225;metros asignados por Cohen<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> y ampliados por Rosenthal<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a>&#58; trivial &#40;&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41;&#44; peque&#241;o &#40;0&#44;2-0&#44;5&#41;&#44; moderado &#40;0&#44;5-0&#44;8&#41;&#44; grande &#40;0&#44;8-1&#44;3&#41; y muy grande &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#44;3&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Resultados</span><p id="par0125" class="elsevierStylePara elsevierViewall">La muestra total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>113&#41; estaba compuesta por un 82&#44;3&#37; de mujeres &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>93&#41; y un 17&#44;7&#37; de hombres &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#46; La edad media de las mujeres participantes fue de 19&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#59; la de los hombres&#44; de 18&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los datos correspondientes a la realizaci&#243;n de los test de RCP se muestran en las <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Analizando los valores absolutos seg&#250;n las recomendaciones de la ERC<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; para la variable MP se encontraron valores significativamente inferiores al utilizar las APP CPR Pro y MC et DSA en comparaci&#243;n con T-PHONE&#44; con un tama&#241;o del efecto peque&#241;o &#40;0&#44;35 y 0&#44;45&#44; respectivamente&#41;&#46; La APP CPR Pro tambi&#233;n mostr&#243; valores significativamente inferiores en comparaci&#243;n con T-RCP&#44; con un tama&#241;o del efecto peque&#241;o &#40;0&#44;34&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de RM se aprecia que los grupos Pocket CPR y MC et DSA mantienen la media de RM dentro de las recomendaciones de la ERC al realizar las tres pruebas &#40;no se encuentran diferencias significativas&#41;&#46; Sin embargo&#44; en el grupo CPR Pro&#44; en el que T-RCP y T-PHONE no alcanzan las recomendaciones de la ERC&#44; se aprecian diferencias significativas al realizar T-APP &#40;0&#44;30 vs T-RCP y 0&#44;35 vs T-PHONE&#41;&#44; mostr&#225;ndose un valor medio dentro de las recomendaciones &#40;113&#44;7 compresiones por minuto&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de los valores porcentuales de la RCP &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> y <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41; se observa que para las variables CPM&#44; CRC y CPC ninguna de las APP utilizada mostr&#243; mejor&#237;as o empeoramiento significativos al compararlos con T-RCP y T-PHONE &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">En la variable RC&#44; que representa el porcentaje de compresiones con un ritmo entre 100 y 120 compresiones por minuto&#44; se encontraron resultados significativamente mayores al comparar T-APP con T-RCP&#46; Los tama&#241;os del efecto al utilizar las diferentes APP fueron los siguientes&#58; Pocket CPR&#58; 0&#44;44&#59; CPR Pro&#58; 0&#44;35&#59; MC et DSA&#58; 0&#44;34&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; en las APP Pocket CPR y CPR Pro tambi&#233;n se observaron porcentajes significativamente mayores al compararlos con la prueba T-PHONE&#44; siendo el tama&#241;o del efecto en el primer caso de 0&#44;53 y en el segundo de 0&#44;41&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Analizando la calidad global de la RCP&#44; expresada en la variable QRCP&#44; los valores obtenidos son siempre inferiores al 34&#37; en todas las pruebas&#46; Con ninguna de las APP se consiguen mejor&#237;as estad&#237;sticamente significativas&#44; observ&#225;ndose incluso un descenso de la calidad significativo al comparar la APP MC et DSA con la prueba T-PHONE&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discusi&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">Nuestro estudio investig&#243; la eficacia de las compresiones tor&#225;cicas comparando tres APP &#40;T-APP&#41;&#58; Pocket CPR&#174;&#44; CPR Pro&#174; y MC et DSA&#174; con RCP sin dispositivo &#40;T-RCP&#41; y RCP con el tel&#233;fono apagado &#40;T-PHONE&#41;&#46; Los sujetos de este estudio no mejoraron los resultados con la RCP guiada por APP y en algunos casos incluso empeoraron&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Este estudio surge de las numerosas investigaciones sobre la RCP con feedback y la mejora de la calidad de la reanimaci&#243;n tanto de legos como de profesionales de la salud<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">12&#44;21-24</span></a>&#46; Varios estudios han mostrado que diferentes dispositivos que ofrecen feedback aumentan la calidad de las compresiones tor&#225;cicas&#44; especialmente ritmo y profundidad&#44; cuando son utilizados por personas con formaci&#243;n en RCP<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Los estudiantes de esta investigaci&#243;n no ten&#237;an formaci&#243;n previa y su primer contacto con la RCP fue la familiarizaci&#243;n inicial con la APP antes de los test&#46; La falta de pr&#225;ctica instrumental puede ser un importante factor limitante&#44; al igual que en estudios con socorristas en los que se ventila mejor boca a boca y no con bal&#243;n resucitador<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a>&#44; o en estudios sobre intubaci&#243;n en los que se obtienen mejores resultados sin intubar<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a>&#46; En ocasiones los mecanismos dise&#241;ados para mejorar la RCP&#44; si no se tiene la formaci&#243;n&#44; el entrenamiento o la experiencia&#44; no consiguen su finalidad&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Un dispositivo de retroalimentaci&#243;n debe utilizarse cuando existen pruebas estad&#237;sticas de validez y fiabilidad como herramienta de medici&#243;n<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a>&#46; En esta l&#237;nea&#44; y siguiendo las recomendaciones de la <span class="elsevierStyleItalic">US Food and Drug Administration</span><a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a>&#44; es necesaria una regulaci&#243;n sobre las APP m&#233;dicas de forma que se asegure su validez y fiabilidad&#46; Las APP de este estudio no mejoraron la profundidad de la compresi&#243;n&#44; quiz&#225; por la falta de habilidad de los reanimadores&#44; por la falta de precisi&#243;n de la APP o por la incomodidad que puede generar realizar RCP con el tel&#233;fono enlazado en las manos&#46; Otros dispositivos que liberan las manos est&#225;n disponibles en el mercado y pueden ser una alternativa<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Aunque existen varias aplicaciones para entrenamiento en resucitaci&#243;n&#44; no todas se ci&#241;en a las recomendaciones de las sociedades cient&#237;ficas y no est&#225;n testadas su precisi&#243;n y usabilidad<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a>&#46; Debido a esto&#44; la calidad de la reanimaci&#243;n puede variar dependiendo del dispositivo de feedback utilizado<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a>&#46; En este sentido&#44; el estudio de Park et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a> evalu&#243; la utilizaci&#243;n de la aplicaci&#243;n Pocket CPR colocando el smartphone en tres posiciones &#40;agarrado con la mano&#44; con un brazalete sobre la mano y con un brazalete en el brazo&#41;&#46; En cualquiera de los tres casos las mediciones de profundidad de compresi&#243;n tor&#225;cica obtenidas no mostraron validez para ninguno de los tres sitios&#44; atribuyendo el error al sistema por el cual se obtienen los datos&#44; el aceler&#243;metro&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; las APP han conseguido mantener la frecuencia de compresiones en valores significativamente superiores cuando fue comparada con los otros test&#46; En la RCP guiada por dispositivos con retroalimentaci&#243;n se han encontrado mejoras en cuanto al ritmo<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">35&#44;36</span></a>&#46; Sin embargo&#44; elementos simples como dispositivos led o metr&#243;nomos pueden mejorar esta variable<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a> sin la necesidad de ocupar las manos con un dispositivo m&#243;vil&#46; La profundidad de las compresiones ha sido insuficiente en todos los test realizados&#44; aun con el uso de las APP&#46; No llegar a la profundidad adecuada es un factor concurrente en numerosos estudios con legos<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a>&#46; Diversos motivos pueden provocar una carencia en la profundidad de las compresiones&#58; formaci&#243;n&#44; experiencia o una retroalimentaci&#243;n inexacta&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Las aplicaciones m&#243;viles han revolucionado en muchos aspectos el aprendizaje de la RCP<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> o la activaci&#243;n de testigos pr&#243;ximos a accidentes&#44; logrando un incremento en la realizaci&#243;n de RCP por partes de testigos<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a>&#46; Sin embargo&#44; la utilizaci&#243;n de APP como ayuda para la ejecuci&#243;n de la RCP de calidad debe ser estudiada y complementada con evidencias m&#225;s s&#243;lidas&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Limitaciones del estudio</span><p id="par0195" class="elsevierStylePara elsevierViewall">La muestra ha estado compuesta por estudiantes de enfermer&#237;a&#44; por lo que&#44; a pesar de no tener formaci&#243;n&#44; pueden tener una motivaci&#243;n hacia la RCP diferente a otras poblaciones&#46; Este es un estudio con maniqu&#237;es&#44; por lo que los resultados pueden no ser trasladables a la pr&#225;ctica cl&#237;nica&#46; Los resultados del uso de una APP en una v&#237;ctima real o en un escenario que no sea simulado pueden generar datos diferentes&#46; Todos los participantes usaron el mismo Smartphone&#44; y esto tambi&#233;n puede ser un factor limitante&#44; ya que no todos los tel&#233;fonos tienen los mismos tama&#241;os y las mismas prestaciones&#59; por tanto&#44; los hallazgos han de ser tomados con precauci&#243;n&#46; La falta de entrenamiento t&#233;cnico para la sujeci&#243;n del Smartphone o la falta de experiencia de los sujetos puede ser otro factor limitante&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conclusi&#243;n</span><p id="par0200" class="elsevierStylePara elsevierViewall">A la vista de los resultados&#44; en esta investigaci&#243;n de simulaci&#243;n y para la muestra estudiada&#44; la RCP guiada por APP en dispositivos m&#243;viles no mejor&#243; la calidad de las compresiones durante la reanimaci&#243;n&#46; La &#250;nica variable que experiment&#243; mejor&#237;a usando APP fue el porcentaje de compresiones realizadas a un ritmo correcto&#46; La profundidad media de la compresi&#243;n parece ser el factor m&#225;s limitante para alcanzar compresiones de calidad&#44; independientemente del tipo de test o APP&#46; M&#225;s estudios son necesarios para ahondar en la utilidad de las aplicaciones m&#243;viles como herramientas proveedoras de feedback en la RCP&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Contribuci&#243;n de los autores</span><p id="par0205" class="elsevierStylePara elsevierViewall">Felipe Fern&#225;ndez-M&#233;ndez&#58; concepci&#243;n y dise&#241;o del estudio&#44; adquisici&#243;n de datos&#44; an&#225;lisis e interpretaci&#243;n de los datos&#44; borrador del art&#237;culo y revisi&#243;n cr&#237;tica&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Roberto Barcala-Furelos&#58; concepci&#243;n y dise&#241;o del estudio&#44; an&#225;lisis e interpretaci&#243;n de los datos&#44; revisi&#243;n cr&#237;tica&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Mart&#237;n Otero-Agra&#58; concepci&#243;n y dise&#241;o del estudio&#44; adquisici&#243;n de datos&#44; an&#225;lisis e interpretaci&#243;n de los datos y revisi&#243;n cr&#237;tica&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Mar&#237;a Fern&#225;ndez-M&#233;ndez&#58; concepci&#243;n y dise&#241;o del estudio&#44; adquisici&#243;n de datos&#44; an&#225;lisis e interpretaci&#243;n de los datos y revisi&#243;n cr&#237;tica&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Myriam Santos-Folgar&#58; concepci&#243;n y dise&#241;o del estudio&#44; adquisici&#243;n de datos&#44; an&#225;lisis e interpretaci&#243;n de los datos y revisi&#243;n cr&#237;tica&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Antonio Rodr&#237;guez-N&#250;&#241;ez&#58; concepci&#243;n y dise&#241;o del estudio&#44; an&#225;lisis e interpretaci&#243;n de los datos&#44; revisi&#243;n cr&#237;tica&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Todos los autores han aprobado la versi&#243;n definitiva de este manuscrito&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Financiaci&#243;n</span><p id="par0240" class="elsevierStylePara elsevierViewall">Los autores declaran no haber recibido financiaci&#243;n para la realizaci&#243;n de este estudio&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicto de intereses</span><p id="par0245" class="elsevierStylePara elsevierViewall">El Dr&#46; Roberto Barcala-Furelos ha participado en el desarrollo de una APP de ense&#241;anza de la RCP &#40;RCP coach&#174;&#41; que no fue testada ni mencionada en este estudio&#46; Los autores declaran no tener conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" 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="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio cuasi-experimental de corte transversal&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Participantes</span><p id="spar0015" 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="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Intervenciones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se realizaron tres test de RCP solo manos con compresiones continuas&#58; 1&#41;<span class="elsevierStyleHsp" style=""></span>RCP sin dispositivo&#59; 2&#41;<span class="elsevierStyleHsp" style=""></span>RCP con el tel&#233;fono apagado&#44; y 3&#41;<span class="elsevierStyleHsp" style=""></span>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="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Variables de inter&#233;s principales</span><p id="spar0025" 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="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0030" 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="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0035" 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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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objective</span><p id="spar0040" 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="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional quasi-experimental study was carried out&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Participants</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A sample of 113 nursing students participated in the study&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Interventions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Three hands-only CPR tests with continuous compressions were performed&#58; &#40;i&#41;<span class="elsevierStyleHsp" style=""></span>without external help&#59; &#40;ii&#41;<span class="elsevierStyleHsp" style=""></span>with the mobile phone turned off&#59; and &#40;iii&#41;<span class="elsevierStyleHsp" style=""></span>guided by APP&#46; Three different APPs were randomly assigned &#40;Pocket CPR&#174;&#44; CPR Pro&#174;&#62; 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="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Variables of primary interest</span><p id="spar0060" 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="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Overall CPR quality was 33&#46;3&#37; &#177; 32&#46;7 using Pocket CPR&#44; 10&#46;9&#37; &#177; 22&#46;72&#37; using CPR Pro and 7&#46;8&#37; &#177; 9&#46;2 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="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="spar0070" 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>"
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            0 => array:2 [
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                0 => """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media &#40;DT&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\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="#tblfn0010"><span class="elsevierStyleSup">b</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  " align="left" valign="\n
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                  \t\t\t\t">114&#44;3 &#40;21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Pocket CPR<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPR Pro<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</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
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                  \t\t\t\t">16&#44;3 &#40;24&#44;9&#41;&nbsp;\t\t\t\t\t\t\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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