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Abstract

Introduction: Children transferred from community hospitals lacking specialized pediatric care are more ill than those presenting directly to pediatric care centers. Outcomes improve with pediatric consultation as does survival if providers adhere to management guidelines. Little research exists regarding whether telemedicine virtual presence can improve adherence to guidelines. Hypothesis: To evaluate impact of pediatric critical care medicine(PCCM) consultation via telemedicine vs. telephone on community hospital adherence to guidelines. Methods: We conducted a randomized controlled trial of in situ mock scenarios using high fidelity simulation of critically ill children presenting to a community hospital that progressed to cardiopulmonary arrest(CPA). Scenarios were randomized to PCCM consultation via telemedicine(intervention) or telephone(control). Primary outcome measure was time to verbalize intent to defibrillate pulseless ventricular tachycardia(PVT). Results: 30 scenarios were completed: 15 intervention and 15 control. Median time(interquartile range-IQR) to verbalizing intent to defibrillate PVT for scenarios was 36 seconds(IQR:12-63); in study arms: Intervention 33(IQR:12-63) vs. Control 39(IQR:11-103), p=0.6. Median time to actual defibrillation for scenarios was 223 seconds(IQR:149-277); in study arms: Intervention 214(IQR:154-262) vs. Control 232(IQR:149-348), p=0.8. Defibrillation in?180 seconds occurred in 37% of scenarios; in study arms: Intervention 33% vs. Control 40%, p=0.7. Correct compression:ventilation ratio was used in 67% of scenarios; in study arms: Intervention 80% vs. Control 53%, p=0.12. Verbalizing request for or use of backboard during CPR occurred in 80% of scenarios; in study arms: Intervention 100% vs. Control 60%, p=0.006. Conclusions: In simulated CPAs, telemedicine did not reduce time to verbalizing intent to defibrillate PVT, but trended toward improved adherence to CPR guidelines for compression:ventilation ratio and improved use of backboard as an adjunct to high quality CPR. This study revealed ways to enhance telemedicine consult, such as providing unobstructed views of the monitor and ensuring there is a focus on high quality resuscitation, i.e. defibrillating in?180 seconds.