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

Ithan D Peltan; David Guidry; Katie Brown; Naresh Kumar; William Beninati; Samuel M Brown

doi:10.1016/j.chest.2022.01.017

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

Chest. 2022 Jul;162(1):111-119. doi: 10.1016/j.chest.2022.01.017. Epub 2022 Jan 19.

Authors

Ithan D Peltan¹, David Guidry², Katie Brown³, Naresh Kumar³, William Beninati⁴, Samuel M Brown⁵

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT. Electronic address: ithan.peltan@utah.edu.
² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT.
⁴ Telehealth Program, Intermountain Healthcare, Salt Lake City, UT; Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT.

Abstract

Background: High-quality leadership improves resuscitation for in-hospital cardiac arrest (IHCA), but experienced resuscitation leaders are unavailable in many settings.

Research question: Does real-time telemedical intensivist consultation improve resuscitation quality for IHCA?

Study design and methods: In this multicenter randomized controlled trial, standardized high-fidelity simulations of IHCA conducted between February 2017 and September 2018 on inpatient medicine and surgery units at seven hospitals were assigned randomly 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 (ie, no-flow fraction) during an approximately 4- to 6-min analysis window beginning with telemedicine activation. Secondary outcomes included other measures of chest compression quality, defibrillation and medication timing, resuscitation protocol adherence, nontechnical 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 = .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 with control resuscitations (10/34 [29%]; P = .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 intervention group resuscitations (39%).

Interpretation: Consultation by a telemedical intensivist physician did not improve resuscitation quality during simulated ward-based IHCA.

Trial registry: ClinicalTrials.gov; No.: NCT03000829; URL: www.

Clinicaltrials: gov.

Keywords: CPR; advanced cardiac life support; critical care telemedicine; in-hospital cardiac arrest; simulation; team dynamics.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Cardiopulmonary Resuscitation* / methods
Heart Arrest* / therapy
Hospitals
Humans
Referral and Consultation
Telemedicine* / methods

Associated data

ClinicalTrials.gov/NCT03000829