Telemedicine for the detection and management of in-hospital and out-of-hospital sudden cardiac arrest: Status quo and quo vadis.

Telemedicine has revolutionised healthcare by enabling the remote delivery of medical services through secure communication technologies. In cardiology, telemedicine has become invaluable for early diagnosis, emergency care, and chronic disease management, addressing challenges like cost and geographic barriers. Sudden cardiac arrest (SCA), a leading cause of mortality, represents a potential area for telemedicine application, though evidence supporting its direct impact on survival remains limited. Despite resuscitation advancements, SCA survival remains under 5 %, primarily due to delayed diagnosis and treatment. Emerging tools-such as wearable sensors, mobile applications, and artificial intelligence-show promise in early warning sign detection; however, most studies remain preliminary, and large-scale validation is lacking. In cases of in-hospital cardiac arrest, telemedicine supports real-time consultations with remote experts. It facilitates adherence to clinical protocols, reduces treatment delays, and integrates cognitive aids to optimize resuscitation efforts. However, existing trials have yielded mixed results, and questions remain regarding feasibility, staffing models, and effective integration during acute events. Telemedicine strengthens the "chain of survival" for out-of-hospital cardiac arrest through telecommunicator cardiopulmonary resuscitation (CPR), boosting bystander CPR rates and improving survival chances. Nevertheless, concerns about added delays, first-responder coordination, and variability in system infrastructure remain critical barriers. Post-resuscitation, telemedicine networks enable evidence-based interventions such as targeted temperature management, demonstrating feasibility and effectiveness in emergency settings. Moreover, remote monitoring of pacemakers and implantable cardioverter defibrillators ensures timely care while reducing outpatient clinic burdens. Integrating artificial intelligence enhances telemedicine's potential by enabling personalized care and predictive analytics. However, limited physical examinations, technical issues, and data privacy concerns persist. Furthermore, restricted physical examinations, infrastructure limitations, and data privacy risks continue to hinder the broader adoption of telemedicine. While telemedicine holds potential to reduce mortality in high-risk scenarios like SCA, its current utility is constrained by technological, logistical, and systemic barriers. Continued research, targeted implementation strategies, and evidence-based integration into emergency care pathways are essential to realize its transformative promise.