Telemedical Intensivist Consultation During In-Hospital Cardiac Arrest Resuscitation: A Simulation-Based, Randomized Controlled Trial

Chest. 2022 Jan 18:S0012-3692(22)00054-X. doi: 10.1016/j.chest.2022.01.017. Online ahead of print.

ABSTRACT

BACKGROUND: High-quality leadership improves the quality of resuscitation for in-hospital cardiac arrest, but experienced resuscitation leaders are unavailable in many settings.

RESEARCH QUESTION: Does real-time telemedical intensivist consultation improve resuscitation quality for in-hospital cardiac arrest?

STUDY DESIGN AND METHODS: In this multicenter randomized controlled trial, standardized high-fidelity simulations of in-hospital cardiac arrest conducted between February 2017 and September 2018 on inpatient medicine and surgery units at seven hospitals were randomly assigned to consultation (intervention) or simulated observation (control) by a critical care physician via telemedicine. The primary outcome was the fraction of time without chest compressions ("no-flow fraction") during an approximately 4-6 minute analysis window beginning with telemedicine activation. Secondary outcomes included other measures of chest compression quality, defibrillation and medication timing, resuscitation protocol adherence, non-technical team performance, and participants' experience during resuscitation participation.

RESULTS: No-flow fraction did not differ between the 36 intervention group (0.22 ± 0.13) and the 35 control group (0.19 ± 0.10) resuscitation simulations included in the intention-to-treat analysis (p=0.41). The etiology of the simulated cardiac arrest was identified more often during evaluable resuscitations supported by a telemedical intensivist consultant (22/32 [69%]) compared to control resuscitations (10/34 [29%], (p=0.001), but other measures of resuscitation quality, resuscitation team performance, and participant experience did not differ between intervention groups. Problems with audio quality or the telemedicine connection affected 14 (39%) of intervention group resuscitations.

INTERPRETATION: Consultation by a telemedical intensivist physician did not improve resuscitation quality during simulated ward-based in-hospital cardiac arrest.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; NCT03000829.

PMID:35063451 | DOI:10.1016/j.chest.2022.01.017