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

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 ( = 22) or the guided app ( = 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 -tests and Fisher's exact tests.

RESULTS

App users showed significantly higher ROSC rate (50 vs. 18%;  = 0.024), correct thrombolytic administration (54 vs. 23%;  = 0.029), backboard use (96 vs. 27%;  < 0.001), end-tidal CO2 monitoring (58 vs. 27%;  = 0.033), and confidence compared with baseline (1.0 vs 0.3;  = 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.