Telemedicine Consultation in Neonatal Resuscitation: A Randomized Crossover Simulation Study

Telemedicine consultation can provide real-time expert support to local teams during neonatal emergencies. This study aimed to assess the impact of telemedicine support on provider performance and user experience during simulated neonatal resuscitation, using three devices of differing technical complexity.

In this randomized crossover study, 93 medical students and doctors completed two neonatal resuscitation scenarios - one without and one with telemedicine support - using one of three randomly assigned devices: a phone, a video telemedicine device, or augmented reality (AR) glasses. The primary outcome, neonatal life support (NLS) performance, was assessed using a 33-item checklist based on a standardized NLS score valuated by two independent raters. Secondary outcomes included user experience, device usability, and participants' gain of performance by using telemedicine support, stratified by participants' level of training.

Resuscitation performance improved significantly with telemedicine support compared to the control scenario (38.37 vs. 33.02 points, p < 0.001), with no difference between the three telemedicine conditions. In the scenario without telemedicine, performance was significantly associated with participant training level, while telemedicine mitigated this effect, yielding the greatest performance gains among untrained users (r = -0.34, p < 0.001). User experience ratings were the lowest for AR glasses, primarily due to technical issues. Less trained participants rated telemedicine as more helpful and beneficial on simulation outcomes.

This simulation-based pilot study demonstrates that telemedicine consultation can significantly improve neonatal resuscitation performance, especially among less trained providers. Differences in user experience underscore that "simple-to-use" technology is needed by healthcare providers when using telemedicine.