Portal de Periódicos da CAPES

Could mobile apps improve laypeople AED use?

2019; Elsevier BV; Volume: 140; Linguagem: Inglês

10.1016/j.resuscitation.2019.05.029

1873-1570

Aida Carballo‐Fazanes, Cristina Jorge-Soto, Cristian Abelairas‐Gómez, Jennifer Bello-Rodríguez, Felipe Fernández-Méndez, Antonio Rodrı́guez-Núñez,

Traumatic Brain Injury Research

In case of cardiac arrest (CA), immediate and high-quality basic life support (BLS) by bystanders is a main outcome factor. This fact, together with the simplicity of the cardiopulmonary resuscitation (CPR) and defibrillator (AED) protocols, has led to the recommendation for training all citizens in BLS.1Greif R. Lockey A.S. Conaghan P. et al.European resuscitation council guidelines for resuscitation 2015. Section 10. Education and implementation of resuscitation.Resuscitation. 2015; 95: 288-301Abstract Full Text Full Text PDF PubMed Scopus (285) Google Scholar In parallel, several feedback devices have been designed to help training and performance both CPR and AED. Mobile Apps have emerged as potential tools to learn and guide how to perform BLS, that are cheaper and simpler than sophisticated manikins. A recent publication reported an increase of CPR quality with the feedback provided by a Smartwatch-App2Lu T.-C. Chang Y.-T. Ho T.-W. et al.Using a smartwatch with real-time feedback improves the delivery of high-quality cardiopulmonary resuscitation by healthcare professionals.Resuscitation. 2019; 140: 16-22Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar and two others evaluated the usefulness of Apps during CPR performance,3Brooks S. Simmons G. Worthington H. Bobrow B. Morrison L. The PulsePoint respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: challenges for optimal implementation.Resuscitation. 2016; 98: 20-26Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar, 4Fernández-Méndez F. Barcala-Furelos R. Otero-Agra M. Fernández Méndez M. Santos-Folgar M. Rodríguez Núñez A. Evaluación sobre la técnica de compresiones torácicas usando APP. ¿Ayudan o entorpecen la reanimación cardiopulmonar?.Med Intensiva [Internet]. 2018; ([April 3rd 2019] Available on: http://www.medintensiva.org/es-evaluacion-sobre-tecnica-compresiones-toracicas-avance-S0210569118302444)Crossref PubMed Scopus (5) Google Scholar but no one assessed the effect of the use of mobile Apps on defibrillation time and quality by laypeople. This fact has motivated our study, which we consider could provide relevant original data. We have selected two mobile Apps (Apple iOS): PCEH and Resucitar because these fulfil the pre-established inclusion criteria: to be free, to include the chain of survival, to indicate pads placement, to indicate execution order and to have a simple interface. We invited first year nursing students of Santiago de Compostela University (Galicia – Spain); to voluntarily participate. The only inclusion criterion was to be naive in BLS and AED use. Sample was randomly distributed into three groups: Control, PCEH and Resucitar. Every participant was tested individually in a CA simulated scenario. AED use and performance were evaluated by means of a for the purpose-checklist that included three main issues: defibrillation objective, safety performance and time to defibrillation. One hundred sixteen participants, 19.5 ± 3.8 years-old were included. Groups assignment and results are shown in Table 1. Ninety (77.6%) participants accomplished the defibrillation objective and statistically significant difference was obtained when Control and Apps groups were compared. Safety during defibrillation procedure was significantly better for participants that used an App during performance than controls (p = 0.014). However, time to defibrillation was shorter in the Control group than in both App groups (without significant differences between Apps).Table 1AED use variables compared by App group.Control (n = 28)PCEH (n = 44)Resucitar (n = 44)P valueDefibrillation objective, n (%)18 (64.3)39 (88.6)33 (75)0.047aChi squared: paired analysis., bControl group vs. PCEH, p = 0.013.Safety, n (%)5 (4.3)03 (2.58)0.014aChi squared: paired analysis., cControl group vs. PCEH, p = 0.004.Time (s), median (IQR)55 (42–70)75 (64–104)75(62–93)<0.001dKruskal Wallis.Time post hoc analysis: Mann Whitney U testControl vs. PCEHControl vs. resucitarPCEH vs. resucitarP < 0.001P = 0.001P = 0.270IQR: interquartile range.a Chi squared: paired analysis.b Control group vs. PCEH, p = 0.013.c Control group vs. PCEH, p = 0.004.d Kruskal Wallis. Open table in a new tab IQR: interquartile range. Our results show that, as simple as the use of AED is, the use of a mobile App as support might be useful in terms of effectiveness and safety during performance, but at the price of some time delay. However, all participants who were able to deliver a shock, did it in less than two minutes, a time compatible with the concept of immediate defibrillation. In conclusion, two iOS based Apps have shown their usefulness for helping naive nurse students to effectively manage an AED in a simulated scenario. More studies should be conducted, in simulated environments with other apps and, ideally, in real patients. The design of new Apps for this purpose should take into account the current evidences and expert recommendations for AEDs use. Also, it would be ideal that Resuscitation Councils' experts checked the new Apps before to their public release. All authors have contributed substantially on the conception and design the work, acquisition, analysis and interpretation of data. In addition, all of them took have been involved in drafting the manuscript and all authors have revising it critically. Finally, all authors have approved the final manuscript. Authors have no conflict of interest related to the present study. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.