JMIR Publications

ABSTRACT

Background:

Evidence-based best practices are the cornerstone to guide optimal cardiopulmonary arrest resuscitation care. Adherence to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. However, a suboptimal quality of CPR remains common in pediatrics, with only approximately 38% of children surviving hospital discharge after in-hospital cardiac arrest and only 6-20% after out-of-hospital cardiac arrest.

Objective:

We investigated whether a mobile app developed as a guide to support and drive CPR providers in real-time through interactive pediatric advanced life support (PALS) algorithms would increase adherence to AHA guidelines and reduce the time to initiation of critical life-saving maneuvers compared to the use of PALS pocket reference cards.

Methods:

This study was a randomized controlled trial conducted during a simulation-based pediatric cardiac arrest scenario-pulseless ventricular tachycardia (pVT). Twenty-six pediatric residents were randomized into two groups. The primary outcome was the elapsed time in seconds in each allocation group from the onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to 1) initiation of chest compression, 2) subsequent defibrillation attempts, and 3) administration of drugs, including the time intervals between defibrillation attempts and drug doses, shock doses, and the number of shocks. All outcomes were assessed for deviation from AHA guidelines.

Results:

Mean time to the first defibrillation attempt (121.4 sec [95% CI 105.3-137) was significantly reduced using the app compared to PALS pocket cards (211.5 sec [95% CI 162.5-260.6], P <.001). With the app, 11/13 (84.6%) residents initiated chest compressions within 60 sec from the onset of pVT and 12/13 (92.3%) successfully defibrillated within 180 sec. Time to all other defibrillation attempts were reduced with the app. Adherence to the 2018 AHA pVT algorithm improved by approximately 70% (P =.001) using the app following all CPR sequences of action in a stepwise fashion until return of spontaneous circulation. The pVT rhythm was recognized correctly in 51/52 (98.1%) opportunities using the app compared to only 19/52 (36.5%) among those using PALS cards (P<.001). Time to epinephrine injection was similar. Among a total of 78 opportunities, wrong shock or drug doses occurred in 14.1% (11/78) of cases among those using the cards. These errors were reduced by 12.8% (1/78, P =.0046) using the app.

Conclusions:

Use of the mobile app was associated with a shorter time to first and subsequent defibrillation attempts, lesser medication and defibrillation dose errors, and improved adherence to AHA recommendations compared with the use of PALS pocket cards. Clinical Trial: Registration was not required as the purpose of the study was to examine the effect of the intervention on healthcare providers.