Editor’s Note: Each month, physician reviewers will evaluate a particular app or category of apps that provide some functionality for medical practices and/or patients.
Each year, 475,000 Americans die from cardiac arrest, according to the American Heart Association (AHA). More than 350,000 cardiac arrests, nearly 75 percent, occur outside of the hospital. Ninety percent of those who experience an out-of-hospital cardiac arrest die. However, studies show that almost 45 percent of those who experience an out-of-hospital cardiac arrest survive when a bystander administers CPR. Unfortunately, only about 46 percent of those suffering from an out-of-hospital cardiac arrest received bystander CPR.
Why then, if the studies show that earlier administration of CPR results in better outcomes, is bystander CPR administered less than half the time? It could be related to bystanders not having prior training. They could be fearful of causing more harm if CPR is performed incorrectly. They could be sitting on the sideline waiting for someone else. They could be concerned about spreading or receiving an illness as a result of performing CPR. Or, they could be concerned about the false idea of having mouth-to-mouth contact with a stranger; the current recommendations for layperson CPR are chest compressions only. Whatever the reason(s)—from self-doubt to being grossed out—it is my opinion that we need to help educate bystanders on how to perform CPR in a pinch, should the situation arise.
The more I thought about it, the more I wondered if there were apps designed for laypeople, non-healthcare professionals, that could help train them by virtually placing them in a situation as a potential bystander. I specifically looked at apps that provided a virtual reality (VR) experience. These apps do require some form of device to place your phone into to get the full experience. They can range from a Google Cardboard VR display to any of the multiple plastic devices you can find on Amazon. I used the View-Master VR Headset to review the following five apps.
CPR Training, created by Warp Industries BV, is a free app that requires the user to wear a VR headset. After a brief instructional tutorial, you are “warped” into a scenario at a mall where you witness an elderly man collapse due to cardiac arrest. You are then tasked to select the correct option from a list of at most four options based on the situation.
The application does an excellent job of building the scenario and allows you to look around in all directions. Despite the excellent VR, the overall experience was rather clunky. Scenarios would end suddenly without explanation, and there is no education to reinforce or correct mistakes.
VirtualCPR does not require a VR headset. Instead, the app, created by Virtualware 2007, places you in a scenario of a virtual body that can perform basic life support. It appears that you can log in if you have an account, but it was not specifically spelled out, nor was there a readily seen help option. I could access the tutorial, which allows you to enter the simulation. The interface was cluttered and didn’t identify labels for the given options. The tutorial took you through step-by-step as to what needed to be performed on the simulator.
It gamified the basic life support procedures and scored you on how well your compressions were, calculated by percent ineffective compressions versus percent effective compressions, response time. It was quite basic, and I was rather disappointed I couldn't get into the actual app to try the scenarios.
There were few customizations during the scenario you could select. For example, if your compressions were ineffective, you could turn on the metronome that plays The Bee Gees’ hit song “Staying Alive” to sync your compressions to the rhythm. It was OK, but I still felt there could be an app that provided a better experience for the layperson.