Rapid response team activation prior to in-hospital cardiac arrest : Areas for improvements based on a national cohort study
(2023) In Resuscitation 193.- Abstract
INTRODUCTION: Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.
METHODS: A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.
RESULTS: In all, 12,915 IHCA patients were included. RRT-reviewed patients (n=2,058) had a lower unadjusted 30-day survival (25% vs 33%,... (More)
INTRODUCTION: Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.
METHODS: A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.
RESULTS: In all, 12,915 IHCA patients were included. RRT-reviewed patients (n=2,058) had a lower unadjusted 30-day survival (25% vs 33%, p<0.001), a propensity score based odds ratio for 30-day survival of 0.92 (95% confidence interval 0.90-0.94, p<0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p<0.001). In the subgroup (n=82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p<0.001).
CONCLUSION: IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.
(Less)
- author
- organization
- publishing date
- 2023-09-22
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Resuscitation
- volume
- 193
- article number
- 109978
- publisher
- Elsevier
- external identifiers
-
- scopus:85173165981
- pmid:37742939
- ISSN
- 1873-1570
- DOI
- 10.1016/j.resuscitation.2023.109978
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
- id
- 7b0d4db2-0480-4517-a5a4-6514a0b7a154
- date added to LUP
- 2023-09-28 20:20:30
- date last changed
- 2024-04-20 19:54:45
@article{7b0d4db2-0480-4517-a5a4-6514a0b7a154, abstract = {{<p>INTRODUCTION: Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.</p><p>METHODS: A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.</p><p>RESULTS: In all, 12,915 IHCA patients were included. RRT-reviewed patients (n=2,058) had a lower unadjusted 30-day survival (25% vs 33%, p<0.001), a propensity score based odds ratio for 30-day survival of 0.92 (95% confidence interval 0.90-0.94, p<0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p<0.001). In the subgroup (n=82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p<0.001).</p><p>CONCLUSION: IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.</p>}}, author = {{Thorén, Anna and Jonsson, Martin and Spångfors, Martin and Joelsson-Alm, Eva and Jakobsson, Jan and Rawshani, Araz and Kahan, Thomas and Engdahl, Johan and Jadenius, Arvid and Boberg von Platen, Erik and Herlitz, Johan and Djärv, Therese}}, issn = {{1873-1570}}, language = {{eng}}, month = {{09}}, publisher = {{Elsevier}}, series = {{Resuscitation}}, title = {{Rapid response team activation prior to in-hospital cardiac arrest : Areas for improvements based on a national cohort study}}, url = {{http://dx.doi.org/10.1016/j.resuscitation.2023.109978}}, doi = {{10.1016/j.resuscitation.2023.109978}}, volume = {{193}}, year = {{2023}}, }