Post Arrest Telemedicine Initiative
Telemedicine within the Emergency Department: Assessing the feasibility and application of a telemedical platform for treating the critically ill patient.
Post-Cardiac Arrest Care:
Cardiac arrest represents a leading cause of death in the US, affecting some 300,000 citizens each year. Upon return of spontaneous circulation (ROSC), rapid and medically sophisticated interventions have demonstrated a substantial survival and functional status benefit. Implementation is inconsistent, resulting in a documented 5-fold regional variation in survival (3% - 16.3%). Current estimates report only 25% of providers, and a third of hospitals, reported using targeted temperature management (TTM) for post-cardiac arrest care. Hospitals are faced with growing numbers of cases and implementation of TTM has become increasingly important, but most hospitals lack the knowledge or experience necessary to achieve high quality outcomes. Given the burden of disease, the recognized gap in quality of care, and the time-sensitive nature of cardiac arrest care, alternative options are critical to providing appropriate care to patients.
Severe Sepsis in the ED:
Sepsis, severe sepsis, and septic shock are a spectrum of disease resulting from a response to systemic infection. Severe sepsis is the 11th leading cause of death, affecting over 750,000 patients per year ($17 billion/year). Rapid identification of patients using lactate as a marker of tissue level hypoperfusion and initiation of an algorithmic resuscitation bundle called Early Goal-Directed Therapy (EGDT) in critical illness have been shown to prevent sudden cardiovascular collapse, progression to multi-organ dysfunction, and has led to a 16- 23.5% mortality reduction. Real time near continual assessment of resuscitation endpoints is the new paradigm, however only 7% of academic EDs reported that EGDT was standard treatment in a national survey in 2005. In a 2010 survey of Pennsylvania EDs, 2/3 reported performing EGDT “more often than not.” Involvement of a sepsis expert early in the resuscitation is important because of limited familiarity and comfort with the targeted resuscitation strategy and also because emergency physicians in private practice are held to patient flow benchmarks.
Telemedicine as an Innovative Tool within the ED:
Telemedical has evolved into sophisticated real-time high-resolution audiovisual conferencing that allows the knowledge, experience, and expertise of a single individual to be virtually present anywhere in the world. Telemedicine has been shown to improve the odds of appropriate treatment decision-making by nearly 11-fold for acute ischemic stroke within the ED proving telemedical consultation to be an effective and feasible option. Given that telemedicine has be shown to be an effective option for other time-sensitive conditions, its use in ED-based critical care may aid in narrowing the observed variation in survival and in the improvement of patient outcomes.
We have built an University of Pennsylvania emergency department based telemedicine network and have begun using the system in order to understand the feasibility of treating critically ill patients – providing 24/7 teleconsultation for patients with severe sepsis/septic shock and for post-cardiac arrest management. Our current telemedicine pilot is currently enrolling patients within multiple EDs.
Interested in hearing more? Want to get involved?
Brendan Carr MD, MA, MS
Benjamin Abella MD, MPhil
David Gaieski MD
Sarah Perman MD
Anish Agarwal MD, MPH
Gail Deflin RN, MSN, CNSMarion Leary MSN, RN