Association of a smartphone-based CPR assistance system with prehospital outcomes in out-of-hospital cardiac arrest: a pre-post observational study in Bangkok.
Resuscitation Plus · 2026-09-10 · Observational study
Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge. Smartphone-based systems may facilitate early bystander response; however, their real-world associations with patient outcomes following implementation within emergency medical service (EMS) systems remain uncertain. OBJECTIVE: This study aimed to evaluate the association between system-level implementation of the MySOS application and prehospital and clinical outcomes among patients with OHCA in Bangkok. METHODS: We conducted a retrospective uncontrolled before-after observational study of patients with OHCA in Bangkok, Thailand, between December 2022 and May 2024. Patients were classified according to the pre- and post-implementation periods of the MySOS application. Inverse probability of treatment weighting (IPTW) and weighted multivariable regression were used to account for measured differences between the study periods. Given the temporal definition of exposure and absence of confirmed patient-level application use, findings were interpreted as associations rather than causal effects. RESULTS: Among 615 patients, 340 (55.3%) were included in the pre-implementation period and 275 (44.7%) in the post-implementation period. The post-implementation period was associated with a higher probability of return of spontaneous circulation (ROSC) (adjusted RD 6.28%, 95% CI 1.69-10.86; p = 0.007), although the corresponding RR was not statistically significant (RR 1.21, 95% CI 0.78-1.89). Differences in death at the scene were also observed between study periods (adjusted RD 14.70%, 95% CI 9.14-20.27; p < 0.001). No statistically significant differences were observed in 24-h survival, survival to hospital admission, or survival to hospital discharge. CONCLUSIONS: The post-implementation period of the MySOS system was associated with a higher probability of ROSC, but not with improved longer-term survival outcomes. These findings should be interpreted cautiously because of the uncontrolled before-after design, residual baseline imbalance, potential temporal confounding, and the absence of patient-level data confirming actual application use. Further prospective studies incorporating direct measures of MySOS activation and utilization are warranted.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Mortality & survival · Implementation · Decision support tools
Related articles
- Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association. (Circulation, 2018)
- Impact of dispatcher-assisted cardiopulmonary resuscitation, advanced life support training, and physician experience on out-of-hospital cardiac arrest outcomes in Mostar: a 10-year retrospective cohort study. (Resusc Plus, 2026)
- Enhancing out-of-hospital cardiac arrest survival in China through the 5-minute social rescue circle implementation. (Resuscitation, 2026)
- Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for Bystander CPR. (JAMA Netw Open, 2024)
- International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2). (Resuscitation, 2022)
- Improved Out-of-Hospital Cardiac Arrest Survival with a Comprehensive Dispatcher-Assisted CPR Program in a Developing Emergency Care System. (Prehosp Emerg Care, 2021)