An Advanced Cardiac Life Support Application Improves Performance during Simulated Cardiac Arrest

Abstract

Objectives Variability in cardiopulmonary arrest training and management leads to inconsistent outcomes during in-hospital cardiac arrest. Existing clinical decision aids, such as American Heart Association (AHA) advanced cardiovascular life support (ACLS) pocket cards and third-party mobile apps, often lack comprehensive management guidance. We developed a novel, guided ACLS mobile app and evaluated user performance during simulated cardiac arrest according to the 2020 AHA ACLS guidelines via randomized controlled trial.

Methods Forty-six resident physicians were randomized to lead a simulated code team using the AHA pockets cards (N = 22) or the guided app (N = 24). The primary outcome was successful return of spontaneous circulation (ROSC). Secondary outcomes included code leader stress and confidence, AHA ACLS guideline adherence, and errors. A focus group of 22 residents provided feedback. Statistical analysis included two-sided t-tests and Fisher's exact tests.

Results App users showed significantly higher ROSC rate (50 vs. 18%; p = 0.024), correct thrombolytic administration (54 vs. 23%; p = 0.029), backboard use (96 vs. 27%; p < 0.001), end-tidal CO2 monitoring (58 vs. 27%; p = 0.033), and confidence compared with baseline (1.0 vs 0.3; p = 0.005) compared with controls. A focus group of 22 residents indicated unanimous willingness to use the app, with 82% preferring it over AHA pocket cards.

Conclusion Our guided ACLS app shows potential to improve user confidence and adherence to the AHA ACLS guidelines and may help to standardize in-hospital cardiac arrest management. Further validation studies are essential to confirm its efficacy in clinical practice.

Keywords

clinical decision support - ACLS - cardiac arrest - iOS - mobile app

Data Availability

The experimental data and the simulation results that support the findings of this study are available upon request.

Code Availability

Our Swift UIKit code is not publicly available at the time of publication due to institutional intellectual property policy.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by Brigham and Women's Hospital's Institutional Review Board.

Authors' Contribution

Co-principal investigators: J.C., N.C.

^* Co-first authors: Michael J. Senter-Zapata, Dylan V. Neel.

Publication History

Received: 25 April 2024

Accepted: 18 July 2024

Article published online:
02 October 2024

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