Clinical features of a series of patients in life-threatening situations at a COVID-19 pandemic field hospital, evaluated by teleconsultation: evidence for Telemedicine expansion

Tarso Augusto Duenhas Accorsi1, Alexandra Régia Dantas Brigido1, Karine De Amicis1, Deborah de Sá Pereira Belfort1, Fábio Cetinic Habrum1, Fernando Garcia Scarpanti1, Iuri Resedá Magalhães1, José Roberto de Oliveira Silva Filho1, Leon Pablo Cartaxo Sampaio1, Maria Tereza Sampaio de Sousa Lira1, Renata Albaladejo Morbeck1, Carlos Henrique Sartorato Pedrotti1, Fábio de Castro Jorge Racy2, Eduardo Cordioli1


DOI: 10.31744/einstein_journal/2021CE6370
Dear Editor, Coronavirus disease (COVID-19) patients who are admitted due to respiratory distress may present gastrointestinal bleeding and thrombotic events, as well as renal, cardiac, hepatic and neurologic complications. (1) These patients require advanced medical resources and longer length of hospital stay, leading to overburdened hospitals and emergency field hospital construction with massive physician hiring. (2) In this scenario of human resources scarcity and high risk of transmission, Telemedicine has been a useful tool, helping healthcare providers properly manage complex cases despite the frontline medical team heterogeneity. Telemedicine provides excellent access to subspecialists, whose assessment can be crucial in the patient care process. (3) Although the COVID-19 pandemic has escalated the use of Telemedicine worldwide and its benefits have been described in multiple medical settings, including disasters and public health emergencies, no study has analyzed the clinical features and interventions of Telemedicine-evaluated patients in life-threatening situations, at a field hospital. (4) This study addresses a case series of severely-ill adult patients admitted to the Hospital de Campanha do Pacaembu (São Paulo, SP, Brazil). All attending physicians had access to the Hospital Israelita Albert Einstein (HIAE) Telemedicine Center, at São Paulo (SP, Brazil), through dedicated hardware and requested on-demand teleconsultations to senior emergency physicians. Retrospectively, 16 consecutive adult patients (>18 years) were enrolled between April and June 2020. The inclusion criteria were patients presenting einstein (São Paulo). 2021;19:1-2 Accorsi TA, Brigido AR, De Amicis K, Belfort DS, Habrum FC, Scarpanti FG, Magalhães IR, Silva Filho JR, Sampaio LP, Lira MT, Morbeck RA, Pedrotti CH, Racy FC, Cordioli E deterioration of clinical status due to dyspnea or hypotension. The complete clinical and test data were compiled for eligible patients. We excluded patients with internet connection problems. All statistics are descriptive only.
According to the local attending physicians' clinical judgment, Telemedicine was triggered for specialist evaluation if the patient was facing severe clinical deterioration. Interventions guided or discussed via Telemedicine are listed in table 1. All patients were evaluated by real-time video conference with a local attending physician and a senior emergency physician, available 24x7, at the Telemedicine Center. In all cases, consultants advised initiating or expanding antibiotic therapy. In ten cases (62.5%), consultants guided pointof-care ultrasound, and few patients were prescribed vasopressors, vasodilators, neuromuscular blockers and corticosteroids.
Step-by-step, invasive ventilation placement was performed for two patients (12.5%).
Therefore, the present case series shows that emergency care video consultation can be a viable solution in pandemic situations at field hospitals, despite potential communication challenges. Another study also presented evidence that video call contact is possible even in critical conditions, such as sepsis and post-cardiac arrest care. (5) In the given cohort, the remote specialists were only called upon in case of highcomplexity clinical scenarios; even though, relevant interventions could be advised, potentially saving lives.
Telemedicine is a reality in health services, reducing medical intervention time and demonstrating high diagnostic accuracy and cost-effectiveness, thereby supporting the further improvement of Telemedicine solutions in these domains. (6) Considering the data presented, senior emergency physician teleconsultation for severely-ill patients can be a feasible and effective alternative to an in-situ evaluation in pandemic situations.