This multicenter randomized trial will employ in-situ cardiac arrest simulations ("mock codes") to test whether using telemedicine technology to add an intensive care physician as the "copilot" for cardiac arrest resuscitation teams influences chest compression quality, resuscitation protocol adherence, team function, and provider experience.
Only 15-30% of patients who suffer in-hospital cardiac arrest (IHCA) survive to hospital discharge. Factors associated with lower mortality and improved function include provision of high-quality, minimally-interrupted chest compressions and swift defibrillation of eligible arrhythmias. Unfortunately, resuscitation teams provide suboptimal care to 25-40% of IHCA victims. A dedicated IHCA team "copilot" may improve resuscitation team performance by providing the team leader with parallel analysis, situational awareness augmentation, action checking, protocol verification, and error correction. Critical care physician involvement via a telemedicine link could allow experienced specialists to fill the "copilot" role in a cost and resource-efficient manner, particularly in smaller hospitals with fewer available physicians. The current study will evaluate how consultation by an off-site intensive care physician via a telemedicine link influences local IHCA teams' quality of care, team function and provider experience during simulated cardiac arrest events ("mock codes").
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
1,001
Standardized consultation to on-site cardiac arrest team by off-site intensivist via two-way audiovisual link using a mobile telemedicine cart
Display of silent, pre-recorded, non-interactive videotape of an ICU physician. The on-site cardiac arrest team will be told that an intensive care physician is observing the mock code.
American Fork Hospital
American Fork, Utah, United States
Intermountain Medical Center
Murray, Utah, United States
The Orthopedic Specialty Hospital
Murray, Utah, United States
McKay-Dee Hospital
Ogden, Utah, United States
Fraction of Pulseless Time With no Chest Compressions
Time frame: From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)
Time From Onset of Shockable Rhythm to Defibrillation
Time frame: From onset of simulated VF or VT until first defibrillation or end of simulation
Fraction of Chest Compressions With Complete Release
Time frame: From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)
Fraction of Chest Compressions at Target Rate
Time frame: From initiation of intervention or placebo control until completion of two complete cycles of CPR (an average of 4 minutes)
Time to First Dose of Epinephrine
Time frame: From initiation of simulation through termination of simulation, an average of 15 minutes
Overall ACLS Protocol Adherence (Using Checklist Adapted From McEvoy ACLS Assessment Tool)
Time frame: From initiation of simulation through termination of simulation, an average of 15 minutes
ACLS Protocol Errors (Using Checklist Adapted From McEvoy ACLS Assessment Tool)
Time frame: From initiation of simulation through termination of simulation, an average of 15 minutes
Team Emergency Assessment Measure Score
The validated "Team Emergency Assessment Measure (TEAM)" evaluates non-technical performance of the on-site resuscitation team. The score (range 0-4) for each simulation was obtained by averaging the mean score for each of 11 component scores (each component item scored 0-4, with higher values representing better performance).
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Park City Hospital
Park City, Utah, United States
Riverton Hospital
Riverton, Utah, United States
LDS Hospital
Salt Lake City, Utah, United States
Time frame: From initiation of simulation through termination of simulation, an average of 15 minutes
Types of Input by Telemedical Intensivist Copilot
Time frame: From initiation of simulation through termination of simulation, an average of 15 minutes
Opinions of Study Subjects About Experience Participating in Simulated Cardiac Arrest, Using a Locally-developed and Validated Survey Instrument
Measured domains: understanding of telemedicine intensivist copilot's role, beliefs about telemedicine intensivist copilot's ability to integrate with on site team, ability to influence on-site team performance, comfort with telemedicine intensivist copilot's role, and function of telemedicine interface
Time frame: Immediately after simulation
Short-form State-Trait Anxiety Inventory Score
The short-form State-Trait Anxiety Inventory (STAI) measures acute stress experienced by respondents using 6 questions (scores for each question range from 1 to 4, with higher values indicating more stress). Analyzed respondent-level values use the total score (range 4-24) obtained by summing the score for each of the six questions, with higher values indicating more respondent-reported acute stress.
Time frame: Immediately after simulation
Presence of Telemedicine Audiovisual Connection Problems for Intervention Group Simulation Event
Time frame: From initiation of simulation through termination of simulation, an average of 15 minutes