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PulsePoint app for cardiac arrest: AP story left us with more questions than answers

Rating

4 Star

Categories

APP HELPS SAVE SEATTLE CARDIAC PATIENT

Our Review Summary

Emergency callThis is a story about the use of an app called PulsePoint in the care of a Seattle victim of sudden cardiac arrest.

In the process of telling a patient story that ended well, the reader is provided with information on the app’s development, its current use across the country and how the reader can become involved in what can best be described as the crowdsourcing of out-of-hospital care for victims of cardiac arrest.

While certainly an intriguing use of technology that merits news discussion, the story left us with questions: What research was conducted to show this app is beneficial? And how solid was that research? What are the potential harms or downsides of using an app in this way? How typical was the patient’s story?

 

Why This Matters

An American Heart Association report released in 2015 noted that there are approximately 326,000 cases of out-of hospital-cardiac arrests in the United States. The survival rate with good neurologic function is approximately 8%. Importantly, just about one-third of the victims survive when cardiac arrest is witnessed.

An app that advises people nearby of an event, especially those who are trained in CPR, is likely to save additional lives–but how do we know for sure? And are the potential harms worth it? The story should have explained how proof is being collected, if at all.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story notes how the PulsePoint Foundation’s app is available for free download for both iOS and Android. We think that it would have been useful to put the URLs in the story, though, as well as note that CPR training is available for free in most locations.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story puts the benefits of the PulsePoint app into perspective: “It’s not clear how many lives have been saved,” it states, further hedging: “Patient confidentiality laws often prevent hospitals from disclosing a patient’s outcome.”

This is enough to merit a Satisfactory rating–but with several caveats:

  • We weren’t sure which scenarios this app is being used for. From what we can tell, it’s strictly for sudden cardiac arrest, and not for other emergencies like seizure, choking, trauma, etc.
  • More than 2,000 cities are said to have adopted the app. This makes us wonder what evidence was used to convince them it’s beneficial? Was any research conducted?
  • In the patient anecdote in the story, many of the 41 people in his vicinity who were alerted were likely to be healthcare workers with knowledge in performing CPR. Is this typical? Probably not, and a more realistic patient anecdote would have been balanced the story better.
  • We also think this story missed an opportunity to highlight the state of research about how well CPR works, since readers likely don’t know these stats. A few studies and reports suggest that, overall, CPR can save about 10% of lives. Unwitnessed cardiac arrests outside of a hospital have a 4% survival rate. Meanwhile, your average bystander CPR has an 8% survival rate. Doing only chest compressions (no breathing) increases survival to 13%. If a person has a “shockable” heartbeat (i.e. with a defibrillator), that nearly triples the survival rate to 37%. It’s also worth mentioning that the success rate of CPR drops by 7-10% for every minute in delay of defibrillation — so the earlier a person is helped, and with an AED or similar device, the better.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Harms and downsides weren’t discussed. But with this app being used so widely and in so many cities, isn’t data available?

One simple harm is the app simply failing to work. Another harm could be untrained or inexperienced people trying to help and causing harm from not knowing what they’re doing. Do people who sign up to use the app have to prove any sort of competency? Also, could bystanders who respond become hurt? For example, are 911 operators first establishing if the situation is safe for others to intervene before issuing an alert?

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

As mentioned above, no one is sure how well it works to save lives, and the story makes this clear. But it should have gone a step further and clarified: Has any research at all been done? On the same note: Why do more cities keep adopting it? What evidence is being used to convince them to sign up?

Does the story commit disease-mongering?

Satisfactory

No disease mongering here.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The reader is provided with quotes from Mr. DeMont and his wife, the developer of the app and two of the responders as well as information from unnamed Seattle officials.

However, we wanted to hear from an outside emergency medicine expert to weigh in and respond to the story’s information/claims.

Does the story compare the new approach with existing alternatives?

Not Applicable

We don’t think that the direct alternative (no access to PulsePoint linkage to a locale’s 911 system) needed to be discussed.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

It is clear that the app is now available and for free.

Does the story establish the true novelty of the approach?

Not Applicable

It’s clear that this is a feature story about a readily available app and how more people are finding out about it and using it, so we’ll rate this N/A. However, it would have been useful to mention if there are any other apps that work in this way, or not.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There is no evidence that the story relies on a news release.

Total Score: 5 of 8 Satisfactory

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