Video-assisted cardiopulmonary resuscitation via smartphone improves quality of resuscitation

Abstract

BACKGROUND Despite intensive research, cardiac arrest remains a leading cause of death. It is of paramount importance to undertake every possible effort to increase the overall quality of cardiopulmonary resuscitation (CPR) and improve patient outcome. CPR initiated by a bystander is one of the key factors in survival of such an incident. Telephone-assisted CPR (T-CPR) has proved to be an effective measure in improving layperson resuscitation. OBJECTIVE We hypothesised that adding video-telephony to the emergency call (video-CPR, V-CPR) enhances the quality of layperson resuscitation. DESIGN This randomised controlled simulation trial was performed from July to August 2018. Laypersons were randomly assigned to video-assisted (V-CPR), telephone-assisted (T-CPR) or control (unassisted CPR) groups. Participants were instructed to perform first aid on a mannequin during a simulated cardiac arrest. SETTING This study was conducted in the Skills Lab of the University Hospital of Cologne. PARTICIPANTS One hundred and fifty healthy adult volunteers. INTERVENTION The participants received a smartphone to call emergency services, with Emergency Eye video-call in V-CPR group, and normal telephone functionality in the other groups. T-CPR and V-CPR groups received standardised CPR assistance via phone. MAIN OUTCOME MEASURES Our primary endpoint was resuscitation quality, quantified by compression frequency and depth, and correct hand position. RESULTS Mean compression frequency of V-CPR group was 106.4 ± 11.7 min, T-CPR group 98.9 ± 12.3 min (NS), unassisted group 71.6 ± 32.3 min (P < 0.001). Mean compression depth was 55.4 ± 12.3 mm in V-CPR, 52.1 ± 13.3 mm in T-CPR (P < 0.001) and 52.9 ± 15.5 mm in unassisted (P < 0.001). Total percentage of correct chest compressions was significantly higher (P < 0.001) in V-CPR (82.6%), than T-CPR (75.4%) and unassisted (77.3%) groups. CONCLUSION V-CPR was shown to be superior to unassisted CPR, and was comparable to T-CPR. However, V-CPR leads to a significantly better hand position compared with the other study groups. V-CPR assistance resulted in volunteers performing chest compressions with more accurate compression depth. Despite reaching statistical significance, this may be of little clinical relevance. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT03527771)

Live video from bystanders’ smartphones to improve cardiopulmonary resuscitation

“…Table 3 -Description of out-of-hospital cardiac arrest cases where the quality of the cardiopulmonary resuscitation was not improved after Videoinstructed Dispatcher-assisted cardiopulmonary resuscitation. Yang and colleagues 17 found improved compression rate and depth, whereas both Stipulante and colleagues, 19 and Ecker and colleagues 16 found improved hand position and compression rate. Different positions of the smartphone may facilitate monitoring and feedback on different aspects of CPR quality.…”

“…Simulation studies often compare audio-instructed DA-CPR with video-instructed DA-CPR for one bystander from the beginning of the call. [16][17][18][19][20] In a simulation setting, a video-call can be initiated from the beginning, whereas the caller in a real situation always first connects to the dispatcher by traditional audio-call. Therefore, direct comparison of audio-only-DA-CPR versus videoinstructed DA-CPR can be difficult on time-related quality parameters in real OHCA.…”

Impact of video quality when evaluating video-assisted cardiopulmonary resuscitation: a randomized, controlled simulation trial

“…However, device and image quality parameters were not mentioned. More recently, in two of our own previous studies, we tested V-CPR via smartphones in a randomized controlled trial on 150 participants in a wifi-setting and under realistic conditions in a metropolitan area using a mobile telephone network [ 13 , 18 ]. Both studies used a video livestream from a Samsung Galaxy S7, which delivers a video quality comparable to the medium and high quality setting in the present study.…”

“…Surprisingly, communication with emergency authoritieswhich is one of the most crucial communication imaginableseems to be unaffected by these trends and remains a traditional "audio-only" phone call. So far, to our best knowledge, video-assisted CPR has only been adopted and is commercially available in very few regions [13,18,19]. Nevertheless, studies have demonstrated that video calls can provide additional information to improve emergency communication, especially in conjunction with CPR [11][12][13][18][19][20][21][22].…”

“…So far, to our best knowledge, video-assisted CPR has only been adopted and is commercially available in very few regions [13,18,19]. Nevertheless, studies have demonstrated that video calls can provide additional information to improve emergency communication, especially in conjunction with CPR [11][12][13][18][19][20][21][22]. Fig.…”