Mobile applications enhance out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis.

Abstract

Introduction: Mobile applications, as innovative tools for promoting bystander cardiopulmonary resuscitation (CPR), have demonstrated potential to improve outcomes for patients experiencing out-of-hospital cardiac arrest (OHCA). This meta-analysis sought to systematically review the technical features of existing mobile applications and evaluate their impact on OHCA patient outcomes under various emergency response strategies. The findings aimed to guide the development and optimization of prehospital public emergency response systems.

Methods: A systematic search was conducted in databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Database (VIP), SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library, from inception to August 2023. The included studies involved notifying citizens via text messages or smartphone applications to act as first responders or volunteers in OHCA cases. Using a random effects model and subgroup analysis, we synthesized the results to identify sources of heterogeneity and assess outcomes.

Results: Thirteen mobile applications were included, with an average activation rate of 35.3% among patients and a volunteer arrival rate of 53.3%. Compared to traditional emergency medical services, mobile applications significantly improved survival to discharge or 30-day survival rates (RR = 1.34, 95% CI: 1.24-1.44; P < 0.05), return of spontaneous circulation (ROSC) rates upon hospital admission (RR = 1.23, 95% CI: 1.09-1.40; P < 0.05), bystander CPR rates (RR = 1.25, 95% CI: 1.13-1.37; P < 0.05), and bystander defibrillation rates (RR = 1.23, 95% CI: 1.00-1.51; P = 0.05). Subgroup analyses revealed consistent results for bystander CPR rates and survival outcomes, while variations in defibrillation rates and ROSC at admission were observed, indicating potential influences of application design and operational parameters.

Conclusions: This study highlighted the significant potential of mobile applications in enhancing bystander interventions and improving patient outcomes. Addressing challenges such as improving access to automated external defibrillators and raising public awareness remained essential to maximizing their overall effectiveness. PROSPERO REGISTRATION NUMBER: CRD42023477676.