# Real-Time Smartphone Guidance Improves Cardiopulmonary Resuscitation (CPR) Performance in Trained and Untrained Individuals: A Stratified Simulation Study

## TL;DR

A smartphone app improved CPR performance in both trained and untrained individuals, especially helping those without prior training.

## Contribution

A real-time smartphone app was shown to significantly enhance CPR performance during simulations.

## Key findings

- App users had higher total performance scores and step success rates compared to non-users.
- Untrained individuals showed the most improvement in algorithm adherence and chest compression quality.
- A significant interaction was found between app use and BLS certification status.

## Abstract

Introduction: Sudden cardiac arrest continues to be a significant cause of death globally, highlighting the importance of performing effective cardiopulmonary resuscitation (CPR). Technological advancements, such as smartphone applications (apps), offer new opportunities to enhance CPR performance.

Purpose: This study aimed to determine whether a specifically designed smartphone app could improve the effectiveness of CPR among trained and untrained individuals in Greece, potentially contributing to better outcomes for out-of-hospital cardiac arrest (OHCA) victims.

Methods: A stratified randomized controlled trial was conducted with 204 adult participants, stratified by Basic Life Support (BLS) certification and randomized to either receive real-time guidance via a smartphone app or not. All participants managed a standardized OHCA simulation using a Quality Cardiopulmonary Resuscitation (QCPR)-enabled manikin (Laerdal Medical, Stavanger, Norway).

Results: Participants using the app demonstrated significantly higher total performance scores and step success rates compared to those without the app (p < 0.001). The effect was particularly pronounced among individuals without prior BLS certification, who achieved greater improvements in both algorithm adherence and chest compression quality. A significant interaction was observed between app use and BLS status (p = 0.001).

Conclusion: Real-time CPR smartphone guidance significantly improved simulated resuscitation performance in both trained and untrained individuals, with the most substantial effect observed in untrained laypersons. Such apps may help bridge the training gap and promote effective bystander intervention during cardiac arrest emergencies.