Effect of an app-guided advanced cardiac life support algorithm on teamwork, non-technical skills, and workload in simulated in-hospital cardiac arrest: a randomized controlled feasibility trial.

Abstract

In-hospital cardiac arrest carries high mortality despite advances in monitoring, rapid response systems, and adherence to advanced life support (ALS) guidelines. Digital decision-support tools, including mobile applications, are increasingly explored to improve guideline adherence, yet their impact on cognitive workload, team performance, and ALS performance remains uncertain. We conducted a prospective, randomized, simulation-based controlled feasibility trial with 40 interprofessional teams (80 participants) comparing ALS performance with and without the use of the 'CPR Leader' app. Two-person teams were randomized 1:1 to intervention or control and followed standardized in-hospital cardiac arrest scenarios (asystole and ventricular fibrillation). Primary outcomes included team performance (TEAM), non-technical skills (ANTS), and subjective workload (NASA-TLX). Secondary outcomes comprised objective resuscitation metrics, including time to rhythm analysis, defibrillation, medication administration, and chest compression quality. Overall NASA-TLX scores were high but comparable between intervention and control group (mean 49.2 ± 13.6 vs. 54.1 ± 14.6; p = 0.2), with higher effort reported in the app group and higher frustration in the control group. TEAM and ANTS scores showed no evidence of meaningful between-group differences. Across the two scenarios types, ALS performance metrics-including rhythm analysis, defibrillation, medication administration, and chest compression quality-were similar between groups, with the exception of earlier chest compression initiation in the control group during ventricular fibrillation. In this exploratory randomized simulation study involving predominantly experienced in-hospital healthcare professionals, the use of a resuscitation support application did not demonstrate a clear improvement in adherence to guideline-recommended ALS algorithms or resuscitation performance compared with standard practice. These findings likely reflect the high level of participants' clinical experience and should not be generalized to novice providers, mixed-experience teams, prehospital settings, or training environments. Further studies are warranted to evaluate the potential benefits of cognitive aids in less experienced populations and in real-world clinical practice. None.