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.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT; Telecritical Care Program, Intermountain Healthcare, Salt Lake City, UT.
Chest. 2022 Jul;162(1):111-119. doi: 10.1016/j.chest.2022.01.017. Epub 2022 Jan 19.
High-quality leadership improves resuscitation for in-hospital cardiac arrest (IHCA), but experienced resuscitation leaders are unavailable in many settings.
Does real-time telemedical intensivist consultation improve resuscitation quality for IHCA?
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.
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%).
Consultation by a telemedical intensivist physician did not improve resuscitation quality during simulated ward-based IHCA.
ClinicalTrials.gov; No.: NCT03000829; URL: www.
gov.
高质量的领导力可以提高院内心脏骤停（IHCA）的复苏效果，但在许多情况下，经验丰富的复苏领导者都无法获得。
实时远程医疗专家咨询是否能提高 IHCA 的复苏质量？
在这项多中心随机对照试验中，在 2017 年 2 月至 2018 年 9 月期间，在七家医院的住院内科和外科病房进行了 IHCA 的标准化高保真模拟，由一名重症监护医师通过远程医疗对这些模拟随机分配到咨询（干预）或模拟观察（对照）。主要结局是从远程医疗激活开始的大约 4-6 分钟分析窗口内无胸外按压时间的分数（即无血流分数）。次要结局包括其他胸外按压质量、除颤和药物使用时间、复苏方案遵守情况、非技术团队表现以及参与者在复苏参与期间的体验。
意向治疗分析中，36 例干预组（0.22±0.13）和 35 例对照组（0.19±0.10）复苏模拟的无血流分数无差异（P=0.41）。在有远程医疗专家顾问支持的可评估复苏中，模拟心搏骤停的病因识别率更高（22/32 [69%]），而对照组则更低（10/34 [29%]；P=0.001），但其他复苏质量、复苏团队表现和参与者体验的措施在干预组之间没有差异。音频质量或远程医疗连接的问题影响了 14 例干预组复苏（39%）。
在模拟病房内的 IHCA 中，远程医疗专家顾问的咨询并没有提高复苏质量。
ClinicalTrials.gov；编号：NCT03000829；网址：www.clinicaltrials.gov。
