Metelmann Bibiana, Metelmann Camilla, Schuffert Louisa, Hahnenkamp Klaus, Brinkrolf Peter
Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany.
JMIR Mhealth Uhealth. 2018 Nov 6;6(11):e190. doi: 10.2196/mhealth.9651.
In case of a cardiac arrest, start of cardiopulmonary resuscitation by a bystander before the arrival of the emergency personnel increases the probability of survival. However, the steps of high-quality resuscitation are not known by every bystander or might be forgotten in this complex and time-critical situation. Mobile phone apps offering real-time step-by-step instructions might be a valuable source of information.
The aim of this study was to examine mobile phone apps offering real-time instructions in German or English in case of a cardiac arrest, to evaluate their adherence to current resuscitation guidelines, and to test their usability.
Our 3-step approach combines a systematic review of currently available apps guiding a medical layperson through a resuscitation situation, an adherence testing to medical guidelines, and a usability evaluation of the determined apps. The systematic review followed an adapted preferred reporting items for systematic reviews and meta-analyses flow diagram, the guideline adherence was tested by applying a conformity checklist, and the usability was evaluated by a group of mobile phone frequent users and emergency physicians with the system usability scale (SUS) tool.
The structured search in Google Play Store and Apple App Store resulted in 3890 hits. After removing redundant ones, 2640 hits were checked for fulfilling the inclusion criteria. As a result, 34 apps meeting all inclusion criteria were identified. These included apps were analyzed to determine medical accuracy as defined by the European Resuscitation Council's guidelines. Only 5 out of 34 apps (15%, 5/34) fulfilled all criteria chosen to determine guideline adherence. All other apps provided no or wrong information on at least one relevant topic. The usability of 3 apps was evaluated by 10 mobile phone frequent users and 9 emergency physicians. Of these 3 apps, solely the app "HELP Notfall" (median=87.5) was ranked with an SUS score above the published average of 68. This app was rated significantly superior to "HAMBURG SCHOCKT" (median=55; asymptotic Wilcoxon test: z=-3.63, P<.01, n=19) and "Mein DRK" (median=32.5; asymptotic Wilcoxon test: z=-3.83, P<.01, n=19).
Implementing a systematic quality control for health-related apps should be enforced to ensure that all products provide medically accurate content and sufficient usability in complex situations. This is of exceptional importance for apps dealing with the treatment of life-threatening events such as cardiac arrest.
在心脏骤停的情况下，旁观者在急救人员到达之前开始心肺复苏可提高生存几率。然而，并非每个旁观者都了解高质量复苏的步骤，或者在这种复杂且时间紧迫的情况下可能会忘记这些步骤。提供实时分步指导的手机应用程序可能是一个有价值的信息来源。
本研究旨在检查在心脏骤停情况下提供德语或英语实时指导的手机应用程序，评估其对当前复苏指南的遵循情况，并测试其可用性。
我们的三步法包括对目前可用的指导非专业人员进行复苏的应用程序进行系统评价、对医学指南的遵循情况测试以及对选定应用程序的可用性评估。系统评价遵循系统评价和荟萃分析的首选报告项目的改编流程图，通过应用一致性检查表来测试对指南的遵循情况，并由一组手机频繁用户和急诊医生使用系统可用性量表（SUS）工具对可用性进行评估。
在谷歌应用商店和苹果应用商店进行的结构化搜索产生了3890个结果。去除重复项后，对2640个结果检查是否符合纳入标准。结果，确定了34个符合所有纳入标准的应用程序。对这些应用程序进行分析，以确定欧洲复苏委员会指南所定义的医学准确性。34个应用程序中只有5个（15%，5/34）符合用于确定指南遵循情况的所有标准。所有其他应用程序在至少一个相关主题上提供了错误信息或未提供信息。10名手机频繁用户和9名急诊医生对3个应用程序的可用性进行了评估。在这3个应用程序中，只有“HELP Notfall”应用程序（中位数=87.5）的SUS评分高于公布的平均分数68。该应用程序的评分明显优于“HAMBURG SCHOCKT”（中位数=55；渐近威尔科克森检验：z=-3.63，P<.01，n=19）和“Mein DRK”（中位数=32.5；渐近威尔科克森检验：z=-3.83，P<.01，n=19）。
应加强对健康相关应用程序的系统质量控制，以确保所有产品在复杂情况下提供医学准确的内容和足够的可用性。这对于处理诸如心脏骤停等危及生命事件治疗的应用程序尤为重要。
