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Area of Science:

  • Medical Education
  • Emergency Medicine
  • Cardiology

Background:

  • In-hospital cardiac arrest management variability impacts patient outcomes.
  • Current clinical decision aids like American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) pocket cards and mobile apps may lack comprehensive guidance.
  • Standardization of ACLS protocols is crucial for improving resuscitation success rates.

Purpose of the Study:

  • To develop and evaluate a novel, guided ACLS mobile application for managing in-hospital cardiac arrest.
  • To compare the performance of resident physicians using the guided ACLS app versus traditional AHA ACLS pocket cards in simulated cardiac arrest scenarios.
  • To assess the impact of the guided ACLS app on return of spontaneous circulation (ROSC), code leader stress and confidence, guideline adherence, and error rates.

Main Methods:

  • A randomized controlled trial involving 46 resident physicians leading simulated cardiac arrest teams.
  • Participants were randomized to use either AHA pocket cards (N=22) or the guided ACLS app (N=24).
  • Primary outcome was successful ROSC; secondary outcomes included code leader stress, confidence, guideline adherence, and errors. A focus group provided qualitative feedback.

Main Results:

  • App users achieved a significantly higher ROSC rate (50% vs. 18%, p=0.024).
  • Significant improvements were observed in correct thrombolytic administration (54% vs. 23%, p=0.029), backboard use (96% vs. 27%, p<0.001), and end-tidal CO2 monitoring (58% vs. 27%, p=0.033) among app users.
  • App users reported significantly higher confidence (p=0.005), and 82% preferred the app over pocket cards.

Conclusions:

  • The guided ACLS mobile app demonstrates potential for enhancing user confidence and adherence to AHA ACLS guidelines.
  • The app may serve as a valuable tool for standardizing in-hospital cardiac arrest management.
  • Further validation studies are recommended to confirm the app's efficacy in real-world clinical settings.