TibetCPR: A Multimodal Tactile Feedback System to Enhance Cardiopulmonary Resuscitation Training in High-Altitude Regions of Tibet (Preprint)

BACKGROUND Background: High-quality cardiopulmonary resuscitation (CPR) is critical for survival, but traditional training methods often fail to maintain learner engagement and ensure long-term skill retention. Serious games have emerged as a powerful strategy to address these challenges. However, their application remains under-explored in resource-limited, high-altitude regions like Tibet, where unique environmental and infrastructural barriers impede effective CPR education. OBJECTIVE Objective: This study developed and evaluated TibetCPR, a wearable serious game designed to teach and reinforce CPR skills under high-altitude conditions. Unlike conventional training systems, TibetCPR integrates gamified elements—including scoring, real-time feedback, and adaptive difficulty—to deliver an immersive learning experience tailored to local constraints. METHODS Methods: We designed a serious game built on three core pillars. First, a Narrative and Reward System immerses players in a rescue scenario where successful CPR compressions visually restore a patient's health from red to green. Each life saved contributes to a persistent "Life Tree," providing long-term motivation. Second, Real-time Feedback Mechanics use integrated audiovisual and electro-tactile cues to instantly guide player performance on compression rate and depth. Third, an Adaptive Difficulty Engine, powered by a hybrid CNN-LSTM model and a Q-learning algorithm, analyzes player performance to dynamically adjust feedback and personalize the challenge. The game's efficacy was evaluated in a quasi-experimental study (N=40), with player engagement assessed via the System Usability Scale (SUS) and qualitative feedback. RESULTS Results: After a 10-minute training session, participants using TibetCPR showed significantly greater improvement in compression accuracy and rhythm control compared to controls. The game’s score-driven progression, adaptive difficulty, and real-time multimodal feedback contributed to high engagement and effective learning, reflected in high System Usability Scale scores and positive user feedback. CONCLUSIONS Conclusions: TibetCPR demonstrates that a serious game-based approach, tailored for extreme environments and cultural contexts, can significantly improve CPR training outcomes. Its low cost and engaging design make it a promising tool for scalable, equitable emergency training in underserved regions.