Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug:177:7-15.
doi: 10.1016/j.resuscitation.2022.06.008. Epub 2022 Jun 18.

Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care

Uchenna R Ofoma  1 , Anne M Drewry  2 , Thomas M Maddox  3 , Walter Boyle  2 , Elena Deych  4 , Marin Kollef  5 , Saket Girotra  6 , Karen E Joynt Maddox  4 ; American Heart Association's Get With The Guidelines®- Resuscitation Investigators
Affiliations

Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care

Uchenna R Ofoma et al. Resuscitation. 2022 Aug.

Abstract

Background: Survival rates following in-hospital cardiac arrest (IHCA) are lower during nights and weekends (off-hours), as compared to daytime on weekdays (on-hours). Telemedicine Critical Care (TCC) may provide clinical support to improve IHCA outcomes, particularly during off-hours.

Objective: To evaluate the association between hospital availability of TCC and IHCA survival.

Methods: We identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. We used 2-level hierarchical multivariable logistic regression to investigate whether TCC availability was associated with better survival, overall, and during on-hours (Monday-Friday 7:00 a.m.-10:59p.m.) vs. off-hours (Monday-Friday 11:00p.m.-6:59 a.m., and Saturday-Sunday, all day, and US national holidays).

Results: 14,373 (32.2%) participants suffered IHCA at hospitals with TCC, and 27,032 (60.6%) occurred in an ICU. There was no difference between TCC and non-TCC hospitals in acute resuscitation survival rate or survival to discharge rates for either IHCA occurring in the ICU (acute survival odds ratio [OR] 1.02, 95% CI 0.92-1.15; survival to discharge OR 0.94 [0.83-1.07]) or outside of the ICU (acute survival OR 1.03 [0.91-1.17]; survival to discharge OR 0.99 [0.86-1.12]. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival (P =.37 for interaction) or survival to discharge (P =.39 for interaction).

Conclusions: Hospital availability of TCC was not associated with improved outcomes for in-hospital cardiac arrest.

Keywords: Cardiopulmonary arrest; Cardiopulmonary resuscitation; Critical Care; Tele-Critical Care; Tele-ICU; Telehealth; Telemedicine.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

Dr. Joynt Maddox serves on the Health Policy Advisory Council for the Centene Corporation (St. Louis, MO). All other authors have declared no conflict of interest

All GWTG participating institutions were required to comply with local regulatory and privacy guidelines and, if required, to secure institutional review board approval. Because data were used primarily at the local site for quality improvement, sites were granted a waiver of informed consent under the common rule.

Figures

Figure 1:
Figure 1:. Derivation of the Study Cohort
Figure 2:
Figure 2:. Survival Rates following In-Hospital Cardiac Arrest
Odds Ratios and 95% Confidence Intervals showing differences between TCC and non-TCC hospitals overall, and during on- or off-hours, for (A&C) Acute Resuscitation Survival rate, and (B&D) Survival to Discharge rate, for IHCA occurring in either (A&B) ICU, or (C&D) non-ICU locations.
Figure 3:
Figure 3:. Hospital-level Variation in Survival rates
This figure shows the (A) Risk-Adjusted Acute Resuscitation Survival rates, and (B) Survival to Discharge rates for individual TCC (blue) or non-TCC (red) hospitals. Error lines indicate 95% confidence intervals. The dotted horizontal line indicates mean survival rate.
See this image and copyright information in PMC

References

    1. Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States. Circulation Cardiovascular quality and outcomes. 2019;12(7):e005580. - PMC - PubMed
    1. Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. The New England journal of medicine. 2012;367(20):1912–1920. - PMC - PubMed
    1. Ofoma UR, Basnet S, Berger A, Kirchner HL, Girotra S, American Heart Association Get With the Guidelines - Resuscitation I. Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends. J Am Coll Cardiol. 2018;71(4):402–411. - PMC - PubMed
    1. Peberdy MA, Ornato JP, Larkin GL, et al. Survival from in-hospital cardiac arrest during nights and weekends. Jama. 2008;299(7):785–792. - PubMed
    1. Brady WJ, Gurka KK, Mehring B, Peberdy MA, O’Connor RE, American Heart Association’s Get with the Guidelines I. In-hospital cardiac arrest: impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge. Resuscitation. 2011;82(7):845–852. - PubMed

Publication types