A randomised control trial to determine if use of the iResus^©application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency*

Abstract

SummaryThis study sought to determine whether using the Resuscitation Council UK's iResus Ó application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency. Thirty-one doctors (advanced life support-trained within the previous 48 months) were recruited. All received identical training using the smart phone and the iResus application. The participants were randomly assigned to a control group (no smart phone) and a test group (access to iResus on smart phone). Both groups were tested using a validated extended cardiac arrest simulation test (CASTest) scoring system. The primary outcome measure was the overall cardiac arrest simulation test score; these were significantly higher in the smart phone group ( Every year, approximately 30 000 people in the UK have an unexpected cardiac arrest in hospital. Despite significant advances in resuscitation research, survival to hospital discharge following cardiac arrest in adults remains poor [1]. The survival benefit of wellperformed cardiopulmonary resuscitation (CPR) is well documented. Recent evidence from both resuscitation training and in-hospital cardiac arrest suggests that CPR quality is suboptimal [2,3].Human factors affect the quality of CPR and disparity exists between resuscitation theory and its practical application -even experienced teams often perform sub-optimally in simulated resuscitation scenarios [4]. Possible explanations for this include the high-stress environment resulting in poor leadership behaviour, failure to delegate tasks explicitly, poor recall of knowledge and inevitable skill decay [5][6][7].

Healthcare professionals’ use of mobile phones and the internet in clinical practice

“…Given the evidence of smartphones assisting clinical practice 11,13 and the prevalence of use in our study population, it was surprising to find that only 16% had a mobile phone provided by their clinical/healthcare workplace and of note, none were smartphones. Consequently, most healthcare professionals used their privately owned mobile within clinical practice identifying that this was because their clinical/healthcare workplace did not provide them with one (irrespective of type -i.e., smartphone or non-smartphone).…”

“…Thus a few studies have evaluated the efficacy of some apps [11][12][13][14][15] . For example, Flannigan and McAloon found that drug dosage calculator apps increases doctors' and medical students' accuracy and confidence in regards to drug dosage calculations 11 , whereas Low et al found that a specifically designed app improves healthcare professionals' performance in a simulated cardiac arrest emergency scenario 13 . On the contrary, Zanner et al found that nonmedically trained individuals' performance of cardiopulmonary resuscitation in a hypothetical emergency scenario was slower in those using a specifically designed app compared to those without the app 14 .…”

“…Despite the availability of thousands of medical apps 4 , efficacy data regarding some apps 11,13 , and the awareness of potential concerns associated with using smartphones in clinical practice 2, 3,12,[15][16][17] , there is little known in regards to healthcare professionals' use of and attitudes towards using smartphones in clinical practice. Low et al found that after using an app in a simulated emergency resuscitation scenario, participants did not think that using such an app is a reflection of poor training or that it appears unprofessional 13 .…”

“…Low et al found that after using an app in a simulated emergency resuscitation scenario, participants did not think that using such an app is a reflection of poor training or that it appears unprofessional 13 . However, it must be kept in mind that Low et al's study involved a simulated environment, as opposed to real clinical situations, and did not obtain extensive information pertaining to healthcare professionals' attitudes towards using mobiles in clinical practice 13 .…”

Mobile phones and the developing world

“…In anaesthetic practice they have been reported for monitoring neuromuscular function [4], measuring 15-degree tilt in obstetric patients [5] and as an aid during resuscitation [6]. The rise in the use of mobile phones, from concern over their use near sensitive medical devices [7] to their ubiquitous presence in all clinical areas [8], and now their use as medical devices themselves, is extraordinary.…”