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
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Article info
Publication history
Published online: June 17, 2022
Accepted:
June 6,
2022
Received in revised form:
May 16,
2022
Received:
April 8,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
