Breathing and heartbeat can stop for a number of reasons, including heart attack, infections, sepsis or trauma. But this does not have to result with death, if cardiopulmonary resuscitation, known as CPR, is performed on time, which increases chances of survival.
A lot of people collapse on street or public places, and it is up to bystanders to help them by performing CPR until paramedics arrive. But the problem here is that bystanders often don't know what to do, or they are reluctant to help, usually because of mouth-to-mouth resuscitation.
We already reviewed Duke CPR app that educates untrained individuals about compression-only CPR, which is easier to perform and has a higher success rate than standard CPR (with mouth-to-mouth resuscitation).
But breathing and heartbeat can also stop in hospitals due to sudden cardiac arrest or other reasons. While someone might say it is better if it happens while you're surrounded by doctors in the hospital than by bystanders on the street, it does not always guarantee a positive outcome.
Evidence shows that survival to discharge following in-hospital cardiac arrest in adults remains poor, usually because of suboptimal quality of CPR, affected by human factors, such as working in high-stress environment, failure to delegate tasks explicitly due to poor leadership, bad recall of knowledge and inevitable skill decay, as well as disparity between resuscitation theory and its practical application.
This is why having good CPR guidelines is important to healthcare professionals too, helping them improve performance in emergency scenarios and advanced life support; especially if these resuscitation algorithms are readily available on mobile phones.
The UK's Resuscitation Council developed the free iResus app for the iPhone and Android with the aim of improving the performance of advanced life support-certified physicians in emergency scenarios.
The app opens to a simple home screen featuring current adult, pediatric and newborn guidelines, containing algorithms that can be updated any time.
There is also Lifesaver button that links to another mobile app by the same developers, which is a gamified version of CPR instructions aimed at untrained individuals (bystanders).
About section contains the general information about the app and its developers, as well as update log.
The guidelines, of course, are the main feature of iResus app, offering 7 adult and 4 pediatric protocols, as well as guidance on newborn life support.
Both adult and pediatric guidelines include basic and advanced life support, choking, and anaphylaxis, while adult guidelines also include in-hospital resuscitation, bradycardia, and tachycardia algorithms. Guidelines for newborns basically include just one life support algorithm.
As you may see, iResus app offers a wide range of resuscitation guidelines, but since it's primarily designed for healthcare professionals, for the purpose of this review we'll take a closer look at advanced life support (ALS) algorithm.
Tap on the algorithm opens a new screen with the diagram showing the steps you need to follow. There is an Overview button you can tap on to display the complete algorithm. Also, Drugs button shows drug doses for adrenaline and amiodarone.
If you want to follow the guidelines step by step, the user interface allows you to easily follow the algorithm in a decision-tree format.
So if you have unresponsive patient, which stopped breathing normally, you'd be advised to call the resuscitation team, and quickly begin 30:2 CPR, and attach a defibrillator/monitor.
The next step would be assessing the rhythm, and decide the following actions for shockable (ventricular fibrillation or pulseless ventricular tachycardia) or non-shockable (pulseless electrical activity or asystole) rhythm, or the return of spontaneous circulation with ABCDE approach.
For example, if the patient has ventricular fibrillation, you'd be advised to give 1 shock and resume CPR for 2 minutes, while assessing for reversible causes, i.e. hypoxia, hypovolaemia, thrombosis, etc.
Red buttons above the algorithm provides you with more detailed information about these reversible causes, and other things you should take into consideration.
If the patient has a return of circulation after this intervention, you'd be advised to immediately start post-cardiac arrest management.
As you could see, the algorithm for ALS is straightforward and very easy to use via interactive decision-tree format. Similarly, the other algorithms in the iResus app also offer clear and concise guidelines on how to deal with the emergency situations. Pediatric and newborn guidelines are provided in same decision tree format as adult guidelines.
Beside diagrams, some of these algorithms also contain pictures, describing how to perform chest compressions, rescue breaths, or back blows or Heimlich maneuver for choking patients.
It should be noted that iResus app was the subject of the randomized clinical trial that should determine whether using this mobile app improves the performance of doctors trained in advanced life support in a simulated emergency.
The results of the study have shown that ALS-trained physicians who have used the iResus app guidelines, performed better in simulated cardiac arrests than those physicians without access to the app. Of course, these were not actual clinical emergencies, but still, the results of the study suggest there may be a benefit of using the iResus app in clinical settings, in terms of patient outcomes.
We can only recommend iResus app as a must-have for any healthcare provider, as it offers up-to-date resuscitation and advance life support guidelines in an easily accessible and intelligible format.
Benefit: All healthcare providers should have this app installed, especially those working in ER setting