Emergency medical services/brief research report
Cell Phone Cardiopulmonary Resuscitation: Audio Instructions When Needed by Lay Rescuers: A Randomized, Controlled Trial

https://doi.org/10.1016/j.annemergmed.2010.01.020Get rights and content

Study objective

Given the ubiquitous presence of cellular telephones, we seek to evaluate the extent to which prerecorded audio cardiopulmonary resuscitation (CPR) instructions delivered by a cell telephone will improve the quality of CPR provided by untrained and trained lay rescuers.

Methods

We randomly assigned both previously CPR trained and untrained volunteers to perform CPR on a manikin for 3 minutes with or without audio assistance from a cell telephone programmed to provide CPR instructions. We measured CPR quality metrics—pauses (ie, no flow time), compression rate (minute), depth (millimeters), and hand placement (percentage correct)—across the 4 groups defined by being either CPR trained or untrained and receiving or not receiving cell telephone CPR instructions.

Results

There was no difference in CPR measures for participants who had or had not received previous CPR training. Participants using the cell telephone aid performed better compression rate (100/minute [95% confidence interval (CI) 97 to 103/minute] versus 44/minute [95% CI 38 to 50/minute]), compression depth (41 mm [95% CI 38 to 44 mm] versus 31 mm [95% CI 28 to 34 mm]), hand placement (97% [95% CI 94% to 100%] versus 75% [95% CI 68% to 83%] correct), and fewer pauses (74 seconds [95% CI 72 to 76 seconds] versus 89 seconds [95% CI 80 to 98 seconds]) compared with participants without the cell telephone aid.

Conclusion

A simple audio program that can be made available for cell telephones increases the quality of bystander CPR in a manikin simulation.

Introduction

Bystander cardiopulmonary resuscitation (CPR) represents one of the few interventions that can improve survival from cardiac arrest, but only about 30% of CPR-trained bystanders will perform CPR.1, 2 Low rates of bystander CPR have been attributed to attitudinal/altruistic differences and fear of disease transmission, as well as training-related factors: poor skill retention after conventional CPR training and bystanders' self-perceived inability to perform CPR correctly.2 These latter factors suggest that the current didactic approach to CPR training needs revision.

Real-time CPR instruction aids—those immediately accessible to assist with resuscitation—might help bystanders perform CPR, and several have been studied. Dispatcher-assisted CPR instructions can increase bystander initiation of CPR and survival outcomes,3, 4 but not all emergency medical services (EMS) call centers have CPR instruction protocols or use them when available.5

Cellular telephones have been studied as CPR instruction aids because most people have them handy at home and in public. Several studies have evaluated the efficacy of using cell telephone video/text software, but participants had difficulty interpreting small screen images.6, 7

We sought to study the applicability of using a simple audio cell telephone program with CPR instructions. In a randomized controlled trial, we tested the differences in quality of CPR performed by CPR-trained and CPR-untrained participants with and without cell telephone audio instructions. We hypothesized that CPR quality (chest compression rate, depth, hand placement, and pauses) would be better for trained participants with the telephone versus trained participants without the telephone and untrained participants with the telephone compared with untrained participants without the telephone.

Section snippets

Study Design

We conducted a prospective study of CPR-trained and -untrained veterans and family members/caregivers, randomized to simulate resuscitating a manikin for 3 minutes with or without assistance from a cell telephone equipped with CPR instructions.

Setting

We recruited subjects (November 2008 to March 2009) by posting a flyer in a large urban Veterans Affairs Medical Center advertising a CPR study with a $20 voucher for study completion.

Selection of Participants

Veterans have high rates of cardiovascular disease and are at risk for

Results

Of the 178 participants who responded to the flyer, 94% (168/178) met eligibility criteria and were scheduled for a study appointment (Figure). Eight did not return for the appointment. Ninety percent (160/178) completed the entire study. Of the 160 participants, 94% were men, 78% were black, and 74% reported an average annual income of less than $25,000 per year (Table 1). The average participant age was 52 (7) years (mean [SD]). Randomization generated 4 groups: CPR trained, receiving a

Limitations

We evaluated CPR performance in a manikin simulation, so our findings may not be applicable in an actual arrest in which fear or stress and other factors may limit performance. Our cohort consisted of volunteers (several of whom had previously performed CPR in a real situation), which also limits generalizability to the overall population. Additionally, coin flip may not have allowed for true randomization. Our simulation occurred for 3 minutes, whereas in practice the time until EMS arrival

Discussion

We demonstrated that CPR quality was better when participants used the cell telephone CPR instruction aid, regardless of CPR training history. Several elements of the intervention appear to be most responsible for its overall success.

First, the cell telephone approach provided an appropriate cadence for chest compressions (100/minute). Participants without the telephone (in both the trained and untrained groups) on average provided chest compressions at half the recommended rate (approximately

References (10)

There are more references available in the full text version of this article.

Cited by (56)

  • The Impact of a Mobile Phone Application for Retention of Bleeding Control Skills

    2021, Journal of Surgical Research
    Citation Excerpt :

    Given that the B-Con Course does not require additional re-certification along with the vital role bystanders can provide in preventing prehospital exsanguination due to a variety of possible blunt or penetrating injuries, similar information on how to improve or revive hemorrhage control skills in laypeople is of the utmost importance. Mobile phone applications provide a readily available and efficient platform to facilitate cognitive aid for bystanders during emergency scenarios across various medical interventions.11,17 While visualizing and listening to directions on a handheld phone application may seem to complicate a bystander's awareness of the environment, we found that in our population, it made participants more likely to call 911 without affecting scene safety awareness skills.

  • Innovation in resuscitation: A novel clinical decision display system for advanced cardiac life support

    2021, American Journal of Emergency Medicine
    Citation Excerpt :

    Adherence to ACLS guidelines correlated with increased return of spontaneous circulation (ROSC) in IHCA, and team performance has a significant impact on the quality of resuscitation [3-6]. It has previously been shown that electronic decision support tools and aids can improve adherence to ACLS protocols, however, these aids focus on individual performance and do not emphasize team performance [7-11]. Additionally, there is limited evidence to support the recommended times of interventions during ACLS, and it is difficult to study these times with the current resuscitative model and documentation [12-14].

  • Association between the centralization of dispatch centers and dispatcher-assisted cardiopulmonary resuscitation programs: A natural experimental study

    2018, Resuscitation
    Citation Excerpt :

    In after-centralization counties, the dispatchers provided CPR instructions to 30.3% more bystanders of OHCAs, and the bystanders performed CPR with dispatcher assistance for 19.2% more OHCA patients than observed in before-centralization counties (Table 3). The dispatcher-provided CPR instructions were associated with an increased depth and rate of chest compression and improved quality of bystander CPR, even for bystanders with previous CPR training [2,6,19,20]. Although the rate of increase for total bystander CPR, including the decrease in bystander CPR without dispatcher assistance, was only 9.1%, the effect of the increase in dispatcher-provided CPR instructions in after-centralization counties might improve the quality of bystander CPR for 19.2% more OHCA patients with dispatcher assistance.

View all citing articles on Scopus

Supervising editor: Robert A. De Lorenzo, MD, MSM

Author contributions: RMM, LBB, and DAA conceived and designed the study. RMM and DAA obtained research funding. RMM, BSA, and DAA supervised the conduct of the study and data collection. RMM, EJA, and TMS undertook recruitment of the patients and managed data, including quality control. RMM, JAL, PWG, and DAA provided statistical advice on study design. RMM, BSA, EJA, TMS, LBB, and DAA analyzed the data. RMM drafted the article and all authors contributed substantially to its revision. RMM takes responsibility for the paper as a whole.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This research was supported by funding from the Philadelphia Veterans Affairs Medical Center for Health Equity Research and Promotion pilot grant and the Robert Wood Johnson Foundation Clinical Scholars program at the University of Pennsylvania. The contents do not reflect the views of the Department of Veterans Affairs or the United States Government.

Please see page 539 for the Editor's Capsule Summary of this article.

Reprints not available from the authors.

Publication date: Available online March 4, 2010.

View full text