Abstract
Introduction: Leading hospital code teams is stressful for resident physicians, and variability in training and experience may result in inconsistent care and outcomes. Nearly all bedside aids like AHA advanced cardiovascular life support (ACLS) pocket cards and third-party ACLS mobile apps lack step-by-step guidance or reminders. Our team designed a guided ACLS mobile app to help trainees lead more effective hospital resuscitations and conducted a randomized controlled trial to assess user experience and performance according to 2020 AHA ACLS guidelines. Hypothesis: A guided ACLS app will improve subjective user experience and adherence to AHA ACLS guidelines. Methods: The ACLS mobile app was developed using Swift UIKit. Internal Medicine, Emergency Medicine, Surgery, and Anesthesia residents (N = 46) were randomized to lead a simulated code for cardiac arrest due to massive pulmonary embolism using either AHA pockets cards (N = 22) or the ACLS app (N = 24). User experience was assessed via surveys. Code outcomes, guideline adherence, and errors were analyzed from video recordings. A focus group of 22 residents provided feedback. Statistical analysis was conducted using R software and included two-sided t-tests and Fisher exact tests. Results: App users showed significantly increased confidence (1.0 vs 0.3; p = 0.005), backboard use (96% vs 27%; p <0.001), end-tidal CO2 monitoring (58% vs 27%; p = 0.042), correct thrombolytic administration (54% vs 23%; p = 0.035), and achieving return of spontaneous circulation (50% vs 18%; p = 0.032) compared to controls. Focus group results showed that 100% of the participants would use the app and that 82% preferred the guided app to AHA pocket cards. Conclusions: The guided app improves user confidence and adherence to AHA ACLS guidelines and addresses the need for greater standardization in hospital code management. Validation studies are necessary to confirm its effectiveness in clinical practice.
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