A New App Aims to Improve Effectiveness of Bystander CPR

Published on April 18, 2016
A Canadian crowdsourcing tool, powered by mobile apps, alerts CPR-trained bystanders to the location of any active cardiac arrests nearby, along with available nearby AEDs.

Out-of-hospital cardiac arrest (OHCA) is a significant public health concern. There are 45,000 cases of cardiac arrests in Canada every year, and epidemiological estimates places the global incidence at 95.9 per 100,000 person-years.(1) Experts have long recognized the importance and benefit of early recognition of cardiac arrest and interventions by bystanders. Public education has thus focused on early recognition of cardiac arrest, emergency medical services (EMS) activation, cardiopulmonary resuscitation (CPR) delivery, and use of an automated external defibrillator (AED). Collectively, this is part of the longstanding “chain of survival” approach to cardiac arrest, through which bystanders can play a significant role. From point of arrest, each minute of delay without CPR and defibrillation reduces the probability of survival by 7%–10%. (2) Unfortunately, in persons with OHCA, only 15%–30% receive bystander CPR, and only 3% receive defibrillation with publically accessible AEDs.(3,4) Improving both trained bystander response time and rate can therefore play a crucial role in improving outcomes of individuals who have an OHCA.

Enter: PulsePoint. PulsePoint (www.pulsepoint.org) is a crowdsourced tool that empowers CPR-trained bystanders to locate and provide CPR before the arrival of EMS. There are two apps (PulsePoint: CPR Respond app and its companion PulsePoint: AED app) that may be downloaded for free on both iOS and Android devices. The CPR Respond app alerts CPR-trained mobile phone users to cardiac arrests in close proximity based on their GPS locations. The companion AED app allows public users of the app to identify and update locations of AEDs in their community. This information is verified by local authorities then updated in the CPR Respond app so that first responders can quickly locate nearby AEDs in an emergency.

The first step in implementing PulsePoint in a community is through collaboration with the local EMS (i.e. police, fire, ambulance). The system integration of PulsePoint allows local emergency call centers to send location details of cardiac arrest emergencies to app users. No crowdsourcing effort is complete without the “crowd,” so a crucial next step is a strong community campaign to generate public interest and to encourage CPR-trained citizens to download and register themselves on the app. When the local emergency call center receives a call for a suspected or confirmed cardiac arrest in a public location, they can identify registered CPR-trained persons nearby by using the GPS and mapping features of the app, and alert them via an app notification. The app also displays any publically accessible AEDs in the vicinity. When the EMS arrives, the alert is turned off so that users know that professional responders are on-site.

Local Implementation in Kingston (Canada)

Dr. Steven Brooks, an emergency physician and clinician-scientist at Queen’s University and Kingston General Hospital in Kingston, Canada, was the first to bring the PulsePoint app to a Canadian city, in March 2015. This was done in collaboration with Kingston Fire and Rescue, Kingston General Hospital, Queen’s University, the Heart and Stroke Foundation, and Bell Canada. More than 2,000 people signed up within two weeks of launch. In the past year in Kingston, there were more than 80 calls for possible cardiac arrests in a public space, with an average of eight PulsePoint users notified per call. More data are being gathered and will be analyzed to further clarify the benefits and limitations in the use of PulsePoint in Kingston.

Future Directions

The existence of PulsePoint and similar initiatives is changing the landscape in which trained and willing bystanders can respond to OHCAs. In Stockholm, Sweden, a similar crowdsourcing system, that uses text messages and computer generated calls, found that the incidence of bystander-initiated CPR increased when these notifications were directed at nearby bystanders (62% vs 48%, 95% CI = 6 to 21, P<0.001).(5) Moreover, the potential benefits of crowdsourcing technologies are reflected in the newly-released 2015 recommendations from the International Liaison Committee on Resuscitation (ILCOR), which recommended for the first time the use of social media technologies that recruit CPR-trained bystanders to nearby cardiac arrests.(6) Clearly, more research on the potential benefits and limitations of PulsePoint and similar technologies will be necessary to inform stakeholders and policy makers.

Acknowledgement

We thank Dr. S. Brooks for providing us with his insights and materials for this article, which would not have happened otherwise without his help and dedicated work in bringing PulsePoint to Canada.

REFERENCES

  1. Berdowski J. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010 Nov 1;81(11):1479–87.

  2. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993 Nov;22(11):1652–8.

  3. Abella BS. The importance of cardiopulmonary resuscitation quality. Curr Opin Crit Care. 2013 Jun;19(3):175–80.

  4. Chan TCY, Li H, Lebovic G, Tang SK, Chan JYT, Cheng HCK, et al. Identifying locations for public access defibrillators using mathematical optimization. Circulation. 2013 Apr 30;127(17):1801–9.

  5. Ringh M, Rosenqvist M, Hollenberg J, Jonsson M, Fredman D, Nordberg P, et al. Mobile-Phone Dispatch of Laypersons for CPR in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2015 Jun 11;372(24):2316–25.

  6. Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, et al. Part 4: Systems of Care and Continuous Quality Improvement 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 suppl 2):S397–413.

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