Telemedicine in cardiac arrest protocols: Comparative impact of video and audio dispatcher assistance

Table 1 Summary of included studies, n (%)

Ref.	Ecker et al[20], 2020			Perry et al[19], 2020			Johnsen et al[24], 2008	Lee et al[11], 2011		Peltan et al[15], 2022		Lee et al[9], 2021		Sonkin et al[21], 2022	Meinich-Bache et al[25], 2018		Kim et al[8], 2021
Comparators	Video	Audio	Control	Video	Audio	Filming	Video	Video	Audio	Telemedicine	Control	Video	Audio	Video	Video		Smartphone	BLS
Country	Germany			Israel			Norway	South Korea		United States		South Korea		Israel	Norway		South Korea
Study period	2018-2020			2018-2019			2006-2007	May 2010 to June 2010		2017-2018		2018-2019		2020-2021	2017-2018		2015-2016
Study design	Randomised controlled simulation trial			A simulation study			A simulation study	Randomised controlled simulation trial		Multicenter randomized controlled trial		Retrospective cohort study		A Simulation study	A Simulation study		Retrospective cohort study
Sample size	50	50	50	14	17	18	6	39	39	35	36	387	1722	43	19		199	417
Participants	Adult volunteers			Medical technicians			Dispatchers	Adult volunteers		Physician		adult patients with OHCA		Active paramedics	Bystander and dispatcher		Adult patients with OHCA
Inclusion criteria	Adult volunteers were recruited from the streets surrounding the hospital. Exclusion criteria included age less than 18 and more than 65 years, healthcare providers (medical practitioners, nurses, paramedics), pregnancy, cardiovascular or musculoskeletal diseases, or any other medical condition preventing performance of CPR over 8 minutes			Twenty-five emergency medical technicians acted as EMDs in the three conditions. A mannequin measured five factors that determined the effectiveness of the chest compressions			All had previously assisted CPR in their ordinary work. None of them had used video for dispatcher instructions prior to the trials	The volunteers were lay people without any previous CPR training. The subjects who had difficulty performing compression-only CPR due to their physical condition, those who were not familiar with cellularphone usage and those who had difficulty watching a video on a cellular phone due to poor vision were excluded from the study		All personnel involved in ward-based IHCA resuscitation at each study site were eligible to participate in the study. Composition and training of these ad hoc resuscitation teams varied by study site		After excluding unknown, nonbystander-witnessed arrest cases, and EMS-witnessed arrests cases (n = 2648), presumed non-cardiac etiology (n = 256), and pediatric cases (n = 28), 2109 cases were eligible for the final analysis		Active paramedics at MDA ambulance teams at the time of the study	No specefic criteria		We include adult patients (n = 18) with OHCA of medicalcauses and EMS-attended and dispatchedin. SALS isanadvanced field resuscitation including drug administration by paramedics with video communication-based direct medical direction
Age (years)	32.92 (12.5)	37.6 (13.9)	36.7 (13.9)	NR	NR	NR	33.5	56.6 ± 7.2	55.3 ± 6.2	NR	NR	64.9 ± 16.2	72.2 ± 14.7	NR	NR	NR	82 (77-87)	80 (72-86)
BMI (kg/m2)	24.2 (5.7)	23.7 (3.6)	23.4 (3.7)	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR
Male	19 (38)	15 (30)	13 (26)	NR	NR	NR	1	20 (51.3)	19 (48.7)	NR	NR	263 (68)	1087 (63.1)	30 (70)	NR	NR	79 (39.7)	207 (49.6)
Female	31 (62)	35 (70)	37 (74)	NR	NR	NR	5	19 (48.7)	20 (51.3)	NR	NR	124 (32.0)	635 (36.9)	13(30)	NR	NR	120 (60.3)	210 (50.4)
Has provided CPR	1 (2)	1 (2)	1 (2)	NR	NR	NR	NR	39	39	NR	NR	NR	NR	32	NR	NR	NR	NR
Witnessed an emergency	5 (10)	8 (16)	6 (12)	NR	NR	NR	NR	39	39	NR	NR	NR	NR	32	NR	NR	NR	NR
Had first aid course	47 (94)	47 (94)	50 (100)	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	32	NR	NR	NR	NR

BLS: Basic life support; BMI: Body mass index; CPR: Cardiopulmonary resuscitation; EMD: Emergency medical dispatcher; NR: Not reported; IHCA: In-hospital cardiac arrest; OHCA: Out-of-hospital cardiac arrest; EMS: Emergency medical services; MDA: Magen david adom; SALS: Smartphone-based advanced cardiac life support.