Participating in a medical code is a challenging and often chaotic experience. Simulation is an educational format well suited to teach and practice a systematic approach to the undifferentiated cardiac arrest patient.

CPR game allows an individual to practice a simulated cardiac arrest scenario on an iPhone. The game is won by completing all “critical actions” in a timely manner and avoiding any harmful actions.

CPR game can be played at the trainee, intern, or expert level. The higher the level, the more critical actions must be completed to win. The game starts with a brief EMS history.

Next is the main game screen showing the patient and an extensive menu of interventions. The monitor at the top right will show a cardiac rhythm after pads are placed on the patient. A menu at the bottom of the screen allows the player to evaluate ABCDE, review the H’s & T’s pneumonic for reversible causes of cardiac arrest, place airways and IV/IO access, do procedures, run tests, and use ultrasound.

Feedback on the evaluations, such as “no pulse” or “BL clear BS with bagging” will appear in blue text here. A counter at the top of the screen keeps a tally of the critical actions performed. At any point in the game, the player can click “see progress” at the top of the screen for a list of all critical actions and whether they have been completed or not.

Now to actually play the game! Immediately start with a pulse check by clicking the C on the bottom menu, and place the patient on the monitor by clicking the monitor in top right. If the feedback text on the bottom menu says “No Pulse,” start CPR by touching the hands over the patient’s chest, and adjust the rate of compressions to 100.

Make sure to check the monitor when the pads are in place. If a shockable rhythm is seen, shock can be delivered through the “shock” button. If no shockable rhythm, continue by giving ACLS medications after placing IV/IO access. Click the red icon showing the line on the patient to access the extensive menu of medication options. After evaluating the Airway, start BVM ventilation and evaluate Breathing.

If there are decreased lung sounds, intervene with needle decompression through the procedure menu. Next you can move on from the primary survey to the secondary survey, assessing Disability and Environment/Exposure. Check glucose or temperature through the Tests menu, and cardiac or FAST scans through the ultrasound menu.

The code continues for seven minutes, with pulse and rhythm checks recommended after each two minute round. If the player completes all the critical actions, the patient has return of spontaneous circulation (ROSC) and the player wins! If even one critical action is missed, the game is lost.

Each case comes with a synopsis explaining the cause of arrest (hypovolemia, MI, PEA due to asthma, cardiac tamponade, etc) and the necessary interventions to achieve ROSC. An online tutorial is available to see an example of a winning game.

Likes

  • Interactive game format.
  • Ability to access list of critical actions while playing with transparent scoring.
  • Graphic representation of real time CPR rate.
  • Case explanations with relevant learning points.

Dislikes

  • No pause button.
  • Limited case scenarios with little variation.
  • All or nothing scoring with limited real time feedback. Even if a critical action is missed, the player must complete the full seven minute case before receiving formal feedback that they’ve lost, or check “See Progress” unprompted to figure it out mid-case. If even one action is missed, the case is lost. A graded scoring system plus timely alerts to missed actions would make this feel more like a game.

Healthcare providers that would benefit from the app:
All Advanced Cardiac Life Support (ACLS) certified providers, especially those regularly involved in Emergency Medicine or Critical Care. This may apply to physicians, residents, medical students, paramedics, nurses, and physician assistants.

Conclusions

I worked on three medical codes in the emergency department the week I started playing CPR game, and I can honestly say that it helped me do better in those scenarios. It’s very easy to get lost in the chaos of a code. Prioritizing critical actions and systematically reviewing of the ABC’s is essential. Frequently practicing a systematic ACLS approach makes it easier to keep my wits about me during these stressful situations.

iMedicalApps recommended?
Yes

Rating: (1 to 5 stars) 4.5 stars

1. User Interface – 4 – Takes some practice, but online videos are helpful.

2. Multimedia usage – 4 – Graphics not fancy, but great interactive interface.

3. Price 5 – $1.99

4. Real world applicability  – 5 – Very useful.

iTunes: http://itunes.apple.com/us/app/cpr-game/id430789636?mt=8