Prehospital Advanced Resuscitation with Video Direct Medical Control Using Mobile Smart Device

Abstract

Introduction:

The prognosis for out-of-hospital cardiac arrest (OHCA) remains controversial if a smart device or video is used. In this study, a system was used that provides advanced cardiac life support (ACLS) with direct medical control through remote video calls for OHCA patients. The study investigated how this system will improve survival.

Aim:

The effect of video remote direct medical control using a mobile smart device for cardiac arrest was the main objective of this research.

Methods:

Medical origin OHCA patients over 18 years old for one year were included in the video remote direct medical attempt. Trauma, intoxication, environmental origin, and family disagreement were excluded. The advanced field resuscitation was performed by paramedics with video communication-based medical direction, who were dispatched simultaneously by two ambulances. Video communication was performed by a mobile application or video call. The results and opinions were recorded in a mobile application and a specific website. We analyzed the general characteristics and outcomes of the prehospital ACLS using video communication.

Results:

A total of 11,054 consecutive out-of-hospital cardiopulmonary resuscitation cases were recorded, and 3,352 underwent prehospital ALS using video call. Prehospital ROSC was 23.3%, survival upon hospital arrival was 13.6%, survival admission was 19.5%, survival discharge was 10.6%, and survival with good neurologic outcome was 6.0%. The reasons for no prehospital ALS included no request from a provider (29.1%), cardiac arrest during transport (20.9%), communication failure (11.6%), and family refusal (11.1%).

Discussion:

As a result of providing prehospital ACLS with direct medical direction through remote video calls to cardiac arrest patients, the prehospital ROSC rate, survival admission, and discharge rate improved. Advantages of this type of medical control by video communication were ease of control of the patient`s family, more precise communication with paramedics, and continuous confirmation of the real patient’s status and monitoring parameters.