Clinical paper| Volume 177, P7-15, August 2022

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



      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.


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


      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).


      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).


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


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Holmberg M.J.
        • Ross C.E.
        • Fitzmaurice G.M.
        • et al.
        Annual Incidence of Adult and Pediatric In-Hospital Cardiac Arrest in the United States.
        Circ Cardiovasc Quality Outcomes. 2019; 12e005580
        • Girotra S.
        • Nallamothu B.K.
        • Spertus J.A.
        • Li Y.
        • Krumholz H.M.
        • Chan P.S.
        Trends in survival after in-hospital cardiac arrest.
        New England J Med. 2012; 367: 1912-1920
        • Ofoma U.R.
        • Basnet S.
        • Berger A.
        • Kirchner H.L.
        • 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: 402-411
        • Peberdy M.A.
        • Ornato J.P.
        • Larkin G.L.
        • et al.
        Survival from in-hospital cardiac arrest during nights and weekends.
        JAMA. 2008; 299: 785-792
        • Brady W.J.
        • Gurka K.K.
        • Mehring B.
        • Peberdy M.A.
        • O'Connor R.E.
        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: 845-852
        • Morrison L.J.
        • Neumar R.W.
        • Zimmerman J.L.
        • et al.
        Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association.
        Circulation. 2013; 127: 1538-1563
        • Herasevich V.
        • Subramanian S.
        Tele-ICU Technologies.
        Crit Care Clin. 2019; 35: 427-438
        • Nguyen Y.L.
        • Kahn J.M.
        • Angus D.C.
        Reorganizing adult critical care delivery: the role of regionalization, telemedicine, and community outreach.
        Am J Respir Crit Care Med. 2010; 181: 1164-1169
        • Wilcox M.E.
        • Chong C.A.
        • Niven D.J.
        • et al.
        Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses.
        Crit Care Med. 2013; 41: 2253-2274
        • McCambridge M.
        • Jones K.
        • Paxton H.
        • Baker K.
        • Sussman E.J.
        • Etchason J.
        Association of health information technology and teleintensivist coverage with decreased mortality and ventilator use in critically ill patients.
        Arch Intern Med. 2010; 170: 648-653
        • Morrison J.L.
        • Cai Q.
        • Davis N.
        • et al.
        Clinical and economic outcomes of the electronic intensive care unit: results from two community hospitals.
        Crit Care Med. 2010; 38: 2-8
        • Lilly C.M.
        • Cody S.
        • Zhao H.
        • et al.
        Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes.
        JAMA. 2011; 305: 2175-2183
        • Kohl B.A.
        • Fortino-Mullen M.
        • Praestgaard A.
        • Hanson C.W.
        • Dimartino J.
        • Ochroch E.A.
        The effect of ICU telemedicine on mortality and length of stay.
        J Telemed Telecare. 2012; 18: 282-286
        • Willmitch B.
        • Golembeski S.
        • Kim S.S.
        • Nelson L.D.
        • Gidel L.
        Clinical outcomes after telemedicine intensive care unit implementation.
        Crit Care Med. 2012; 40: 450-454
        • Lilly C.M.
        • McLaughlin J.M.
        • Zhao H.
        • et al.
        A multicenter study of ICU telemedicine reengineering of adult critical care.
        Chest. 2014; 145: 500-507
        • Nassar B.S.
        • Vaughan-Sarrazin M.S.
        • Jiang L.
        • Reisinger H.S.
        • Bonello R.
        • Cram P.
        Impact of an intensive care unit telemedicine program on patient outcomes in an integrated health care system.
        JAMA Intern Med. 2014; 174: 1160-1167
        • Kahn J.M.
        • Le T.Q.
        • Barnato A.E.
        • et al.
        ICU Telemedicine and Critical Care Mortality: A National Effectiveness Study.
        Med Care. 2016; 54: 319-325
        • Wilcox M.E.
        • Adhikari N.K.
        The effect of telemedicine in critically ill patients: systematic review and meta-analysis.
        Crit Care. 2012; 16: R127
        • Peberdy M.A.
        • Kaye W.
        • Ornato J.P.
        • et al.
        Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation.
        Resuscitation. 2003; 58: 297-308
        • Cummins R.O.
        • Chamberlain D.
        • Hazinski M.F.
        • et al.
        Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'.
        American Heart Assoc Circ. 1997; 95: 2213-2239
        • Nadkarni V.M.
        • Larkin G.L.
        • Peberdy M.A.
        • et al.
        First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults.
        JAMA, J Am Med Assoc. 2006; 295: 50-57
        • Jacobs I.
        • Nadkarni V.
        • Bahr J.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).
        Resuscitation. 2004; 63: 233-249
        • Ofoma U.R.
        • Maddox T.M.
        • Perera C.
        • et al.
        Characteristics of U.S. Acute Care Hospitals That Have Implemented Telemedicine Critical Care.
        Crit Care Explor. 2021; 3: e0468
        • Williams D.
        • Lawrence J.
        • Hong Y.R.
        • Winn A.
        Tele-ICUs for COVID-19: A Look at National Prevalence and Characteristics of Hospitals Providing Teleintensive Care.
        J Rural Health. 2021; 37: 133-141
        • Austin P.C.
        Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research.
        Commun Stat - Simul Comput. 2009; 38: 1228-1234
        • Needleman J.
        • Buerhaus P.
        • Pankratz V.S.
        • Leibson C.L.
        • Stevens S.R.
        • Harris M.
        Nurse staffing and inpatient hospital mortality.
        New England J Med. 2011; 364: 1037-1045
        • Neuraz A.
        • Guerin C.
        • Payet C.
        • et al.
        Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study.
        Crit Care Med. 2015; 43: 1587-1594
        • Pronovost P.J.
        • Angus D.C.
        • Dorman T.
        • Robinson K.A.
        • Dremsizov T.T.
        • Young T.L.
        Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review.
        JAMA, J Am Med Assoc. 2002; 288: 2151-2162
        • Wallace D.J.
        • Angus D.C.
        • Barnato A.E.
        • Kramer A.A.
        • Kahn J.M.
        Nighttime intensivist staffing and mortality among critically ill patients.
        New England J Med. 2012; 366: 2093-2101
        • Barger L.K.
        • Ayas N.T.
        • Cade B.E.
        • et al.
        Impact of extended-duration shifts on medical errors, adverse events, and attentional failures.
        PLoS Med. 2006; 3e487
        • Kuhn G.
        Circadian rhythm, shift work, and emergency medicine.
        Ann Emerg Med. 2001; 37: 88-98
        • Rollinson D.C.
        • Rathlev N.K.
        • Moss M.
        • et al.
        The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: a pilot study.
        Ann Emerg Med. 2003; 41: 400-406
        • Scott L.D.
        • Rogers A.E.
        • Hwang W.T.
        • Zhang Y.
        Effects of critical care nurses' work hours on vigilance and patients' safety.
        Am J Crit Care: Official Publication, Am Assoc Crit-Care Nurs. 2006; 15: 30-37
        • Shaffer J.P.
        • Johnson J.W.
        • Kaszuba F.
        • Breslow M.J.
        Crit Care Med. 2005; 33 (A5)
        • Caples S.M.
        Intensive Care Unit Telemedicine Care Models.
        Crit Care Clin. 2019; 35: 479-482
        • Lee J.T.
        • Kerlin M.P.
        ICU Telemedicine and the Value of Qualitative Research for Organizational Innovation.
        Am J Respir Crit Care Med. 2019; 199: 935-936
        • Lilly C.M.
        • Fisher K.A.
        • Ries M.
        • et al.
        A national ICU telemedicine survey: validation and results.
        Chest. 2012; 142: 40-47
        • Peltan I.D.
        • Poll J.B.
        • Guidry D.
        • Brown S.M.
        • Beninati W.
        Acceptability and Perceived Utility of Telemedical Consultation during Cardiac Arrest Resuscitation. A Multicenter Survey.
        Ann Am Thoracic Soc. 2020; 17: 321-328
        • Peltan I.D.
        • Guidry D.
        • Brown K.
        • Kumar N.
        • Beninati W.
        • Brown S.M.
        Telemedical Intensivist Consultation During In-Hospital Cardiac Arrest Resuscitation: A Simulation-Based, Randomized Controlled Trial.
        Chest. 2022;
        • Kahn J.M.
        • Rak K.J.
        • Kuza C.C.
        • et al.
        Determinants of Intensive Care Unit Telemedicine Effectiveness. An Ethnographic Study.
        Am J Respir Crit Care Med. 2019; 199: 970-979
        • Kalvelage C.
        • Rademacher S.
        • Dohmen S.
        • Marx G.
        • Benstoem C.
        Decision-Making Authority During Tele-ICU Care Reduces Mortality and Length of Stay-A Systematic Review and Meta-Analysis.
        Crit Care Med. 2021; 49: 1169-1181
        • Kumar G.
        • Falk D.M.
        • Bonello R.S.
        • Kahn J.M.
        • Perencevich E.
        • Cram P.
        The costs of critical care telemedicine programs: a systematic review and analysis.
        Chest. 2013; 143: 19-29
        • Kahn J.M.
        • Hill N.S.
        • Lilly C.M.
        • et al.
        The research agenda in ICU telemedicine: a statement from the Critical Care Societies Collaborative.
        Chest. 2011; 140: 230-238