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

中文翻译：

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院内心脏骤停复苏期间的远程医疗重症医生会诊

背景

高质量的领导可以改善院内心脏骤停 (IHCA) 的复苏，但在许多情况下缺乏经验丰富的复苏领导者。

研究问题

实时远程医疗重症医生会诊是否可以提高 IHCA 的复苏质量？

研究设计和方法

在这项多中心随机对照试验中，2017 年 2 月至 2018 年 9 月期间，对七家医院的住院内科和外科病房进行了标准化高保真 IHCA 模拟，并随机分配给重症监护医生进行会诊（干预）或模拟观察（控制）。远程医疗。主要结果是在远程医疗激活开始的大约 4 至 6 分钟的分析窗口期间无胸外按压的时间分数（即无流量分数）。次要结局包括胸外按压质量、除颤和用药时机、复苏方案遵守情况、非技术团队表现以及参与者在复苏过程中的体验等其他指标。

结果

意向治疗分析中包含的 36 个干预组 (0.22 ± 0.13) 和 35 个对照组 (0.19 ± 0.10) 复苏模拟中的无流量分数没有差异 ( P = .41 )  。与对照复苏 (10/34 [29%]； P  = .001)相比，在远程医疗重症监护顾问 (22/32 [69%]) 支持的可评估复苏期间，模拟心脏骤停的病因更容易被识别，但其他情况干预组之间的复苏质量、复苏团队表现和参与者体验的衡量标准没有差异。音频质量或远程医疗连接问题影响了 14 名干预组的复苏（39%）。

解释

在模拟病房 IHCA 期间，远程医疗重症医生的会诊并未改善复苏质量。

试验登记处

临床试验.gov；编号：NCT03000829；网址：www.clinicaltrials.gov