Acceptability and Perceived Utility of Telemedical Consultation during Cardiac Arrest Resuscitation. A Multicenter Survey

• Published in: Annals of the American Thoracic Society Vol. 17; no. 3; pp. 321 - 328
• Main Authors: Peltan, Ithan D, Poll, Justin B, Guidry, David, Brown, Samuel M, Beninati, William
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.03.2020
• Subjects: Adult; Attitude of Health Personnel; Cardiac arrest; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Cardiovascular disease; CPR; Female; Heart Arrest - therapy; Hospital Units - organization & administration; Humans; Idaho; Intensive care; Intensive Care Units - organization & administration; Male; Medical Staff, Hospital - psychology; Medical Staff, Hospital - statistics & numerical data; Middle Aged; Nursing Staff, Hospital - psychology; Nursing Staff, Hospital - statistics & numerical data; Referral and Consultation; Telemedicine; Telemedicine - methods; Utah; Idaho; Utah; in-hospital cardiac arrest; telemedicine; survey; cardiopulmonary resuscitation; advanced cardiac life support
• ISSN: 2329-6933; 2325-6621
• DOI: 10.1513/AnnalsATS.201906-485OC

Many clinicians who participate in or lead in-hospital cardiac arrest (IHCA) resuscitations lack confidence for this task or worry about errors. Well-led IHCA resuscitation teams deliver better care, but expert resuscitation leaders are often unavailable. To determine the acceptability and perceived utility of using telemedicine technology to enable remote IHCA resuscitation participation by a critical care physician. We conducted an electronic, anonymous survey of nurses and attending physicians likely to participate in IHCA resuscitation at 21 hospitals in Utah and Idaho. Complete survey responses were received from 855 (59%) of 1,442 clinicians contacted, of whom 764 met all eligibility criteria. Respondents were more likely to prefer that telemedicine physicians take an active role during IHCA events on the ward (83%; 95% confidence interval [CI], 77-88%) or intensive care unit (ICU; 66% [95% CI, 48-81%]) than the emergency department (53% [95% CI, 44-62%]), with most favorable responses recommending the telemedicine physician act as assistant/advisor ("copilot") for the on-site team. The majority of respondents expected a telemedical copilot for IHCA teams to exert a positive or neutral effect on patient care (51% [95% CI, 44-59%] and 33% [95% CI, 30-37%], respectively). Overall, 41% (95% CI, 31-51%) of respondents favored adding a telemedical critical care physician as IHCA team "copilot," 35% (95% CI, 30-40%) were neutral, and 24% (95% CI, 18-32%) were opposed. Clinicians based at smaller hospitals or on the ward or ICU were most likely to foresee beneficial effects from a telemedicine physician "copilot." ICU- and, especially, ward-based IHCA resuscitation teams at community and rural hospitals were amenable to adding a telemedical critical care physician consultant as IHCA team "copilot." Respondents expected the greatest benefits for IHCA events occurring on the wards.