An Opportunity to Standardize and Enhance Intelligent Virtual Assistant-Delivered Layperson Cardiopulmonary Resuscitation Instructions

Importance Intelligent virtual assistants (IVAs) are ubiquitous and hold the potential to provide bystander cardiopulmonary resuscitation (CPR) instructions during an emergency. Objective To evaluate the quality of CPR instructions provided by IVAs. Design We evaluated the appropriateness of responses of four IVAs (Amazon Alexa, Apple Siri, Google Assistant, and Microsoft Cortana) to eight CPR-related questions. We also evaluated text-based responses provided by OpenAI ChatGPT, a recently developed artificial intelligence large language model. Results Out of 32 responses provided by IVAs, only 19 (59%) were related to CPR, 9 (28%) suggested calling emergency services, and 4 (12%) provided verbal CPR instructions. All responses provided by ChatGPT were related to CPR and suggested calling emergency services. Among responses related to CPR, the answers provided varied significantly in the utility of information provided. Conclusions and Relevance These results highlight the need for the technology industry to partner with the medical community to improve and standardize bystander CPR instruction provided by IVAs. Question What is the quality of cardiopulmonary resuscitation (CPR) instruction provided by intelligent virtual assistants (IVAs) including Amazon Alexa, Apple Siri, Google Assistant, and Microsoft Cortana? Findings When asked questions related to CPR, IVAs frequently did not provide relevant information. Moreover, even when the information provided was relevant, actual CPR instruction was not given in most cases. Meaning These results highlight the need to standardize bystander CPR instruction provided by IVAs. ### Competing Interest Statement ABL is a consultant for the Abbott Medical Device Cybersecurity Council. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript