Using Smart Watches to Facilitate High Quality Cardiopulmonary Resuscitation for Patients with Cardiac Arrest

Thesis (Ph.D.)--University of Washington, 2019Survival rates for victims of cardiac arrest remain poor worldwide despite medical advancement and technology development. Chest compression quality has been considered the key for patient survival during cardiopulmonary resuscitation (CPR). Past studies have shown that both healthcare professionals and laypersons often perform CPR at inadequate rates and depths. Prior studies also showed that with adequate feedback, CPR quality can be improved and more adherent to the guideline-recommended rate (100 to 120 per minute) and depth (5 to 6 cm). This dissertation sought to develop a wearable application (app) with real-time feedback mechanism by using a commercially available smartwatch (ASUS ZenWatch 2) to facilitate the delivery of high-quality CPR. First, a systematic review on healthcare applications of smartwatches was conducted by using the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” as the systematic review methodology. After screening 356 articles, 24 were selected for review. The results find that most of the identified smartwatch studies focused on applications involving health monitoring for the elderly (6; 25%), and there is potential for smartwatch use in clinical settings. The second step is to develop a smartwatch app that can accurately estimate the rate and depth of chest compression in real-time, while also providing a user-centered design interface as an assistive device to be used during CPR in clinical settings. By using the sensor data collected from a smartwatch-based accelerometer during chest compressions on a manikin, two novel algorithms capable of estimating chest compression rate and depth were introduced, respectively. The validation study indicates that the developed algorithm based on a smartwatch with a built-in accelerometer is promising. User-centered design was adopted during the user interface development of the prototype and usability testing was conducted for the final app. Finally, to evaluate whether the developed smartwatch app with real-time audiovisual feedback can improve the delivery of high-quality CPR, a total of 80 healthcare professionals were recruited and randomly allocated to either the intervention group wearing a smartwatch with feedback or the control group without a smartwatch. All participants were asked to perform CPR for two minutes, with chest compression and ventilation at a 30:2 ratio. The results show that without feedback chest compressions tend to be too fast and too shallow, and that CPR quality can be improved with the assistance of a smartwatch providing real-time feedback. This work is a great example of applying modern information technology to improve the quality of healthcare. Although it is a simulation study performed on a manikin, it has substantial potential to be utilized in the clinical settings