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Impact of telemedicine on neonatal resuscitation in the emergency department: a simulation-based randomised trial
  1. Katherine Couturier1,
  2. Travis Whitfill1,2,
  3. Ambika Bhatnagar2,
  4. Rajavee A Panchal2,
  5. John Parker1,
  6. Ambrose H Wong1,
  7. Christie J Bruno3,
  8. Marc A Auerbach1,2,
  9. Isabel T Gross2
  1. 1 Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3 Department of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Isabel T Gross, Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT 06511, USA; isabel.t.gross{at}


Background The delivery and initial resuscitation of a newborn infant are required but rarely practised skills in emergency medicine. Deliveries in the emergency department are high-risk events and deviations from best practices are associated with poor outcomes.

Introduction Telemedicine can provide emergency medicine providers real-time access to a Neonatal Resuscitation Program (NRP)-trained paediatric specialist. We hypothesised that adherence to NRP guidelines would be higher for participants with access to a remotely located NRP-trained paediatric specialist via telemedicine compared with participants without access.

Materials and methods Prospective single-centre randomised trial. Emergency Medicine residents were randomised into a telemedicine or standard care group. The participants resuscitated a simulated, apnoeic and bradycardic neonate. In the telemedicine group a remote paediatric specialist participated in the resuscitation. Simulations were video recorded and assessed for adherence to guidelines using four critical actions. The secondary outcome of task load was measured through participants’ completion of the NASA Task Load Index (NASA-TLX) and reviewers completed a detailed NRP checklist.

Results Twelve participants were included. The use of telemedicine was associated with significantly improved adherence to three of the four critical actions reflecting NRP guidelines as well as a significant improvement in the overall score (p<0.001). On the NASA-TLX, no significant difference was seen in overall subjective workload assessment, but of the subscore components, frustration was statistically significantly greater in the control group (p<0.001).

Conclusions In this study, telemedicine improved adherence to NRP guidelines. Future work is needed to replicate these findings in the clinical environment.

  • simulation
  • telemedicine
  • neonatal resuscitation

Statistics from


  • AB, RAP and JP contributed equally.

  • AHW, CJB and MAA contributed equally.

  • KC and ITG contributed equally.

  • Contributors KC, an emergency medicine resident, conceptualised the article and drafted the initial manuscript together with ITG, a paediatric emergency medicine fellow. TW analysed the data. RAP, AB, JP, AHW, TW and CJB participated in project planning process, the data collection, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted.

  • Funding This work was supported by CTSA (grant UL1 TR001863) from the National Center for Advanced Translational Science (NCATS).

  • Competing interests None declared.

  • Ethics approval Our university institutional review board approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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