Editorials
Quality of Bystander Cardiopulmonary Resuscitation – Can a Smartphone Bring About a Revolution? –
2015 Volume 79 Issue 5 Pages 964-965
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2015 Volume 79 Issue 5 Pages 964-965
In order to improve the life saving rate of patients with out-of-hospital cardiac arrest, which occurs in approximately 70,000 people in Japan each year, an increased implementation rate of cardiopulmonary resuscitation (CPR) by the general public and improvement of the quality of bystander CPR are essential.1,2 However, it is not easy for non-health practitioners to master high-quality CPR skills, although various methods have been investigated, because the CPR itself is something out of the ordinary and involves partially invasive procedures.
Article p 1052
In this issue of the Journal, Sakai et al3 report the effect of a CPR support application for smartphones newly developed by the authors on the quality of CPR performed by 84 randomized non-health practitioners. The CPR support application significantly increased the implementation rate and total number of chest compressions and improved CPR skills. In contrast, Merchant et al4 tested the effect of prerecorded audio CPR instructions had on the quality of CPR performed by 160 randomized non-health practitioners using a cell telephone. Those authors reported that even simple audio-guided CPR instructions improved the quality of CPR.
So what difference is there in the effect of the CPR support application on a smartphone, which uses both voice and images, on the quality of CPR from that of voice-only CPR instructions on a cell telephone? Table compares the main items of CPR quality described by Sakai et al and Merchant et al. First, the chest compression rate improved for both the smartphone and cell telephone. Improvements have also been demonstrated in studies that used a metronome,5,6 suggesting that voice alone can provide an adequate improvement. However, although the chest compression depth slightly improved for both the cell telephone and smartphone, the compressions did not reach a sufficient depth, suggesting that this point is difficult to improve with machine guidance. Second, we can see a delay in time to first chest compression of nearly 40 s for both phones, which suggests the possibility that they delay the start of CPR. Whether this is simply because starting the programs requires time is unclear, but in any case, improvement is desirable in the future. Third, although time without chest compression, which is a critical item particularly emphasized in the CPR guidelines as well,1,2 improved for both techniques, it is difficult to assess whether the improvement was sufficient for the cell telephone. The smartphone, in contrast, showed a dramatic improvement of only 4.4 s in a 2-min scenario. It is of great interest to see if this dramatic improvement is simply attributable to the addition of images or if some other factors, including the voice portion, are involved. Further investigation and elucidation of the causes, which may lead to an important discovery in resuscitation science, are expected.
| CPR metrics | Sakai et al3 | Merchant et al4 | ||
|---|---|---|---|---|
| Smart phone (n=43) |
No smart phone (n=41) |
Cell telephone (n=80) |
No cell telephone (n=80) |
|
| Chest compressions | ||||
| Rate/min, mean | 105.8 | 38.5 | 100 | 44 |
| Correct hand position, % | 51.5 | 55.3 | 97 | 75 |
| Depth, mm, mean | 35.0 | 36.7 | 41 | 31 |
| Pauses | ||||
| Time to first cc, s, mean | 37.1 | 31.4 | 48 | 18 |
| Time without cc in the 2-min simulation, s, mean | 4.4 | 63.8 | ||
| Time without cc in the 3-min simulation, s, mean | 74 | 89 | ||
cc, chest compression; CPR, cardiopulmonary resuscitation.
Although the CPR support application is still in development,7 I hope that the new social network technologies, including smartphones, will revolutionize the way we rescue patients with out-of-hospital cardiac arrest.
Conflict of Interests: I have no conflicts of interest to declare.
