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.
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