Crowdsourcing CPR

I have written previously about the potential impact of mobile apps and ubiquitous computing on health and healthcare delivery, but I admit I did not see this one coming. The current issue of The New England Journal of Medicine has a report from a research group in Sweden that developed a system – and tested it in a randomized controlled trial – to use smartphones to alert CPR-trained bystanders when there was a nearby cardiac arrest. This figure from the paper describes how it works:


OHCA is “out of hospital cardiac arrest” and “SMS” is a text message. In the trial they describe, the standard EMS response was always activated, but the text to bystander was randomly activated only half the time.

Here is another figure from the paper that describes the randomization and outcomes in more detail:


The primary outcome of the study was the frequency with which bystander CPR was initiated, and it was too small to demonstrate that the differences in bystander CPR rates improved survival or other outcomes. Here is the detail on that:

Image 3

Other studies (including one in the same issue of NEJM) have shown that increased rates of bystander CPR improve survival, so the improvement in bystander recruitment demonstrated here is both statistically and likely clinically significant.

An editorial that accompanied the article pointed out the challenges of replicating this kind of system in the US, including our more fragmented mobile phone infrastructure and EMS systems and our more litigious environment (so what else is new).

Despite that, I found a few things about this pretty interesting. First, I was surprised at how frequently bystander CPR was done in the control group (48% of the time). That is higher than in the US, where averages about 40% of the OHCA. Second, it triggered a bit of a “why didn’t I think of that” response, since there was no new technology used, just a clever repurposing of what we all have in our pockets already. Finally, it gave me a feeling of “you ain’t seen nothing yet” since we are sure to see the ongoing application of common technology in uncommon ways.

What do you think?

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