The Resuscitation Assistant

Your ultimate support to save lives during the first hour of resuscitation

The biggest challenge in the first hour of resuscitation is rarely establishing the diagnosis. For the majority of patients, the team on the ground quickly has a good idea of the clinical syndrome and the interventions to be carried out to stabilize the patient. 

The real challenge of the first hour of resuscitation is logistical: it is the execution of all of these interventions in a context of extraordinary stress where the patient's life is literally at stake. The logistical burden of resuscitation can be divided into four sections: medications, equipment, procedures, and algorithms.

Of these four sections, it is on medication administration errors that the scientific literature is the most extensive. Medication dosing errors are associated with increased morbidity, patient mortality, and healthcare costs [1-4]. A systematic review conducted in 2006 [5] found that the most frequently identified type of medication error is dosing errors, which often involves a dose ten times higher than the appropriate dose. These medication errors are responsible for significant mortality and morbidity, with approximately 7,000 pediatric patient deaths each year in the United States [6].

In Canada, it is estimated that approximately 2% of admissions see a preventable adverse drug event leading to an increase in length of stay by an average of 4.6 days and an estimated increase in hospital costs of $4,700 per admission. This has a significant effect on the Canadian healthcare system with costs of up to $2.6 billion per year [7]. This problem is not unique to Canada: the costs are estimated at $21 billion per year in the United States [8] and $660 million per year in Australia [9]. 

The scientific literature on other areas of resuscitation, such as equipment selection, procedures and algorithms, is less documented but still part of the same continuum. Indeed, equipment calculation requires the same basic arithmetic rules as drug dosing. These formulas seem simple in principle, but they prove extremely difficult in high-pressure scenarios where a patient's life is literally at stake [10-11].

The same parallel can be applied to procedures. During the first hour of resuscitation, healthcare providers must be able to perform a wide variety of complex procedures, some of which are extremely rare. These procedures involve many steps that must be followed sequentially with little margin for error. Algorithms represent a similar challenge where precise coordination of care is mandatory [12-16]. 

The impact of using a mobile application in intensive care was studied, once again, only in relation to medication errors. The study by Siebert et al. [17] demonstrated that the use of a dosing application reduces drug dosing errors by 68% and preparation time by 45%. In September 2023, Ste-Justine Hospital carried out a vast review of the literature on this specific issue with its Health Interventions and Technologies Evaluation Unit (UETMIS) [18]. 

This working group was charged with independently reviewing the literature on medication dosing errors and evaluating the potential benefits of our first application, EZDrips (EZResus replaced EZDrips in July 2023). The final recommendation of the working group was to recommend the adoption of EZDrips.

In summary, current literature supports that resuscitation is associated with medication dosing errors having a significant impact on patient morbidity and mortality. This represents great stress for healthcare teams and significant costs for the healthcare system. 

Although the literature is still emerging on the subject, the use of an application in an intensive care situation is associated with a reduction in errors and faster administration of medications. Our field experience is that until now, no tool has addressed all the logistical needs of the first hour of resuscitation. Even today, many perfusion calculations are still done by hand (with a sheet of paper and a calculator!), searches are done in books during this time of chaos, procedures are searched frantically on the web. 

The more this care is provided in remote areas, the greater this challenge. Indeed, with limited human and material resources, the list of interventions to be taken care of independently quickly becomes extremely difficult. This is the challenge that our organization has decided to take on.