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Introduction: Telerobotic operation in which a remote surgeon performs an operation over distance has long held the promise of providing a more equitable distribution of healthcare in rural and underserved regions of the world. One of the technological limitations that has hampered the adoption of telerobotic surgery is the need for a broadband connection to transmit high-resolution video of the operative field. Hypothesis: We hypothesized that we could develop a low-bandwidth system for telerobotic cardiac catheter ablation that deploys a virtual reality (VR)-based surgical guidance system to allow remote operation without the need for high-resolution video transmission. Methods: We assembled a portable pre-clinical telerobotic catheter ablation system from commercial-grade components by 3 rd party vendors. Raw sensor data from the catheter ablation system requiring a bitrate of less than 100kb/sec was streamed in real-time over distance using a standard internet connection. We used a proprietary service (DOPL Technologies, Seattle, WA) and an Oculus Quest (Oculus, Inc. Menlo Park, CA) to generate a shared, virtual operative field and operating room environment. No video data was transmitted. The Institutional Animal Care and Use Committee of the University of Washington (Seattle, WA) approved the study performed on a 14-week (27 kg) Yorkshire pig. The operator was located 6 miles from the OR at the time of the operation. Results: A successful proof of concept telerobotic cardiac catheter ablation in an animal model was performed without video transmission. The remote surgeon applied radiofrequency energy lesions in the animal’s cavotricuspid isthmus region. The visual depiction of the operative environment was successfully constructed in virtual reality from sensor data generated from the animal subject and surgical instruments. The remote operator conducted the ablation while interacting in a shared virtual OR environment with members of the surgical team present in the physical operating room and three remote observers. Conclusions: Telerobotic cardiac catheter ablation is feasible without video transmission. This approach could reduce network bandwidth requirements for telerobotic operations in rural areas.

Purpose: We hypothesized that advanced circulatory compromise, as manifested by acidosis and hyperkalemia should be associated with worsened clinical outcomes in cardiac arrest patients treated with therapeutic hypothermia. Methods: Results of initial admission laboratory studies, medical history, and echocardiogram in 203 consecutive cardiac arrest patients (59 females, 59+/- 15 years old) undergoing therapeutic hypothermia were reviewed. Mortality was ascertained through hospital records. ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses were used. The study was approved by the institutional IRB. Results: Increased mortality was noted with older age, decreased admission pH, elevated admission lactate, lower admission hemoglobin, and pulseless electrical activity or asystole as presenting rhythms (Table). Admission hypokalemia and ventricular fibrillation/tachycardia were associated with improved hospital mortality (Table). Potassium was significantly lower in patients admitted with ventricular fibrillation/tachycardia (3.897+/-0.92) as compared to patients with asystole (4.674+/-1.377) or pulseless electrical activity (4.491+/-1.055 mEq/dL, p Conclusions: Hyperkalemia, pulseless electrical activity, and asystole are predictive of increased hospital mortality in survivors of cardiac arrest. An association between low or low-normal potassium, observed VT-VF, and better outcomes is unexpected and may be used for prognostic purposes. More prospective investigations of mortality predictors in these critically ill patients are needed.

Background: We investigated changes in myocardial repolarization and associated outcomes in patients undergoing therapeutic hypothermia after cardiac arrest. Methods: Demographic, clinical, and ECG data on 19 consecutive cardiac arrest survivors (6 females, 59+/-15 years old, 3 with diabetes, 3 with cancer, 3 with CKD, 5 with pulmonary disease and 5 with cardiovascular disease) undergoing therapeutic hypothermia were collected. Absolute QT dispersion was calculated. ANOVA, chi-square, Kaplan-Meier and logistic regression analyses were used. The study was approved by the IRB. Results: Hypothermia resulted in significant prolongation of both minimum (baseline 277+/-74 vs. cooled 408+/-129 vs. re=warmed 313+/-82 msec, p Conclusion: Therapeutic hypothermia is associated with significantly prolonged QT intervals. However, these QT abnormalities do not translate into increased mortality and/or AICD therapy during short or long-term follow-up.