Exploration of the impact of a voice activated decision support system (VADSS) with video on resuscitation performance by lay rescuers during simulated cardiopulmonary arrest

Elizabeth A Hunt; Margaret Heine; Nicole S Shilkofski; Jamie Haggerty Bradshaw; Kristen Nelson-McMillan; Jordan Duval-Arnould; Ron Elfenbein

doi:10.1136/emermed-2013-202867

Exploration of the impact of a voice activated decision support system (VADSS) with video on resuscitation performance by lay rescuers during simulated cardiopulmonary arrest

Emerg Med J. 2015 Mar;32(3):189-94. doi: 10.1136/emermed-2013-202867. Epub 2013 Nov 15.

Authors

Elizabeth A Hunt¹, Margaret Heine², Nicole S Shilkofski³, Jamie Haggerty Bradshaw⁴, Kristen Nelson-McMillan⁵, Jordan Duval-Arnould⁶, Ron Elfenbein⁷

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA Department of Pediatrics, Baltimore, Maryland, USA Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
² Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA Department of Pediatrics, Baltimore, Maryland, USA Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA Perdana University Graduate School of Medicine, Kuala Lumpur, Malaysia.
⁴ Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Uniformed Services of the Health Sciences, Bethesda, Maryland, USA.
⁵ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA Department of Pediatrics, Baltimore, Maryland, USA Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
⁶ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Johns Hopkins Medicine Simulation Center, Baltimore, Maryland, USA.
⁷ Southern Maryland Hospital Center, Clinton, Maryland, USA l St. Mary's Hospital, Leonardtown, Maryland, USA.

PMID: 24243484
DOI: 10.1136/emermed-2013-202867

Abstract

Aim: To assess whether access to a voice activated decision support system (VADSS) containing video clips demonstrating resuscitation manoeuvres was associated with increased compliance with American Heart Association Basic Life Support (AHA BLS) guidelines.

Methods: This was a prospective, randomised controlled trial. Subjects with no recent clinical experience were randomised to the VADSS or control group and participated in a 5-min simulated out-of-hospital cardiopulmonary arrest with another 'bystander'. Data on performance for predefined outcome measures based on the AHA BLS guidelines were abstracted from videos and the simulator log.

Results: 31 subjects were enrolled (VADSS 16 vs control 15), with no significant differences in baseline characteristics. Study subjects in the VADSS were more likely to direct the bystander to: (1) perform compressions to ventilations at the correct ratio of 30:2 (VADSS 15/16 (94%) vs control 4/15 (27%), p=<0.001) and (2) insist the bystander switch compressor versus ventilator roles after 2 min (VADSS 12/16 (75%) vs control 2/15 (13%), p=0.001). The VADSS group took longer to initiate chest compressions than the control group: VADSS 159.5 (±53) s versus control 78.2 (±20) s, p<0.001. Mean no-flow fractions were very high in both groups: VADSS 72.2% (±0.1) versus control 75.4 (±8.0), p=0.35.

Conclusions: The use of an audio and video assisted decision support system during a simulated out-of-hospital cardiopulmonary arrest prompted lay rescuers to follow cardiopulmonary resuscitation (CPR) guidelines but was also associated with an unacceptable delay to starting chest compressions. Future studies should explore: (1) if video is synergistic to audio prompts, (2) how mobile technologies may be leveraged to spread CPR decision support and (3) usability testing to avoid unintended consequences.

Keywords: cardiac arrest; research, operational; resuscitation; resuscitation, effectiveness; resuscitation, research.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Publication types

Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Audiovisual Aids
Cardiopulmonary Resuscitation / education
Cardiopulmonary Resuscitation / methods*
Decision Support Techniques*
Female
Humans
Male
Out-of-Hospital Cardiac Arrest / therapy*
Outcome and Process Assessment, Health Care
Patient Simulation
Prospective Studies
Quality Assurance, Health Care*
Video Recording*