In-hospital cardiac arrest epidemiology in a mature rapid response system

Jones, Daryl; Mercer, Inga; Heland, Melodie; Detering, Karen; Radford, Sam; Hart, Graeme K; O’Donnell, David; Bellomo, Rinaldo

doi:10.12968/hmed.2017.78.3.137

Cited by 16 publications

(16 citation statements)

References 13 publications

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“…Moreover, the frequency of cardiac arrests in our study was 0.32/1,000 admissions. This is far lower than some Australian studies which report a frequency of cardiac arrests between 1.46 and 3.76/1,000 admissions in the context of a medical emergency team (24). This may also be consistent with the fact that some critically ill patients prefer to leave the hospital and to die at home when their situation becomes critical rather than wait to be resuscitated.…”

Section: Comparison With Previous Studiessupporting

confidence: 75%

A rapid response team is associated with reduced overall hospital mortality in a Chinese tertiary hospital: a 9-year cohort study

Gong¹,

Wang²,

Shao³

et al. 2020

Ann Transl Med

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Background: Although the evidence for its effectiveness remains uncertainty, rapid response systems are implemented across many hospitals across the world. Increasingly, hospitals in China have recently started to adopt a medical emergency or rapid response team (RRT). Hence, we aimed to determine whether the implementation of an RRT in Chinese hospitals also improved outcomes. Methods: Our hospital is a Joint Commission International (JCI) accredited, tertiary teaching hospital with 1,200 beds. We conducted a retrospective cohort study comparing 60 months after the implementation of

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Section: Comparison With Previous Studiessupporting

confidence: 75%

A rapid response team is associated with reduced overall hospital mortality in a Chinese tertiary hospital: a 9-year cohort study

Gong¹,

Wang²,

Shao³

et al. 2020

Ann Transl Med

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“…[24][25][26] Even in mature RRS a portion of IHCAs are still preceded by escalation criteria breaches. [27][28][29] Activation of the RRS in the presence of objective escalation criteria in a period of greater than 30 min prior to an IHCA may allow the RRS to prevent the event from occurring. 30,31 Periods of less than 30 min may not be sufficient to allow the RRT to effectively intervene.…”

Section: Recommendation 2: Hospitals Should Measure Predictable Ward mentioning

confidence: 99%

“…IHCAs are associated with escalation criteria breaches that were not acted upon. [27][28][29] Thus, ongoing assessment of the reliability of detection and evaluation of deteriorating patients is warranted.…”

Section: Recommendation 3: Hospitals Should Measure Timeliness Of Thementioning

confidence: 99%

Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems

et al. 2019

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Background Clinically significant deterioration of patients admitted to general wards is a recognized complication of hospital care. Rapid Response Systems (RRS) aim to reduce the number of avoidable adverse events. The authors aimed to develop a core quality metric for the evaluation of RRS. Methods We conducted an international consensus process. Participants included patients, carers, clinicians, research scientists, and members of the International Society for Rapid Response Systems with representatives from Europe, Australia, Africa, Asia and the US. Scoping reviews of the literature identified potential metrics. We used a modified Delphi methodology to arrive at a list of candidate indicators that were reviewed for feasibility and applicability across a broad range of healthcare systems including low and middle-income countries. The writing group refined recommendations and further characterized measurement tools. Results Consensus emerged that core outcomes for reporting for quality improvement should include ten metrics related to structure, process and outcome for RRS with outcomes following the domains of the quadruple aim. The conference recommended that hospitals should collect data on cardiac arrests and their potential preventability, timeliness of escalation, critical care interventions and presence of written treatment plans for patients remaining on general wards. Unit level reporting should include the presence of patient activated rapid response and metrics of organizational culture. We suggest two exploratory cost metrics to underpin urgently needed research in this area. Conclusion A consensus process was used to develop ten metrics for better understanding the course and care of deteriorating ward patients. Others are proposed for further development. Results Consensus was achieved for ten RRS quality metrics, of which four were related to improving population health, three to enhancing the patient experience of care, two to cost and one to enhancing provider well-being. Level of recommendations were graded as "essential," "recommended", "optional" and "experimental". Terms used in the formulation of recommendations are described in Table 1. Table 2 provides a summary of specific numerators, denominators and inclusion and exclusion criteria to be used when tracking each entity. We are aware that many hospitals use a multi level activation system; for these institutions, we provide guidance in Table 2 as to which warning level should be used for a given metric. Recommendation 1: Hospitals should measure and track cardiac arrests of regular ward patients Type of metric: Clinical outcome, essential Description of metric: A cardiac arrest is defined as an event in which a patient receives chest compression and/or defibrillation for a non-perfusing rhythm. The definitions of terms used in this and other metrics are presented in Table 1. Rationale: Retrospective reviews of in-hospital cardiac arrests (IHCA) consistently show that signs of deterioration are present for several hours before the even...

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“…According to the data published by the United Kingdom NCAA for 2011-2013, they have a rate of 1.6 per every 1,000, and specific rates of 1.51-6.28 per every 1,000 patients admitted to US and European hospitals. (3,(20)(21)(22) The probable cause of this clear fluctuation among the institutional rates should be the lack of a consensus when publishing data and the proportion of ICU beds, coronary care unit (CCU) and Catheterization Laboratories (cath-lab) versus the general hospitalization wards. (20) The statistical analysis of epidemiological studies indicates that cardiac arrest is slightly more frequent in males, with 58.3 %-66.2 % of all IHCA cases.…”

Section: Inpatient Cardiac Arrestmentioning

confidence: 99%

“…(3,(20)(21)(22) The probable cause of this clear fluctuation among the institutional rates should be the lack of a consensus when publishing data and the proportion of ICU beds, coronary care unit (CCU) and Catheterization Laboratories (cath-lab) versus the general hospitalization wards. (20) The statistical analysis of epidemiological studies indicates that cardiac arrest is slightly more frequent in males, with 58.3 %-66.2 % of all IHCA cases. (1,3,10) Its incidence is proportional to the age of the patient, with a peak between 52 and 77 years.…”

Section: Inpatient Cardiac Arrestmentioning

confidence: 99%

Post-cardiac arrest syndrome in adult hospitalized patients

Acosta-Gutiérrez

Alba-Amaya

Roncancio-Rodríguez

et al. 2021

Colomb. J. Anesthesiol.

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Adult In-hospital Cardiac Arrest (IHCA) is defined as the loss of circulation of an in-patient. Following high-quality cardiopulmonary resuscitation (CPR), if the return of spontaneous circulation (ROSC) is achieved, the post-cardiac arrest syndrome develops (PCAS). This review is intended to discuss the current diagnosis and treatment of PCAS. To approach this topic, a bibliography search was conducted through direct digital access to the scientific literature published in English and Spanish between 2014 and 2020, in MedLine, SciELO, Embase and Cochrane. This search resulted in 248 articles from which original articles, systematic reviews, meta-analyses and clinical practice guidelines were selected for a total of 56 documents. The etiologies may be divided into 56% of in-hospital cardiac, and 44% of non-cardiac arrests. The incidence of this physiological collapse is up to 1.6 cases/1,000 patients admitted, and its frequency is higher in the intensive care units (ICU), with an overall survival rate of 13% at one year. The primary components of PCAS are brain injury, myocardial dysfunction and the persistence of the precipitating pathology. The mainstays for managing PCAS are the prevention of cardiac arrest, ventilation support, control of peri-cardiac arrest arrythmias, and interventions to optimize neurologic recovery. A knowledgeable healthcare staff in PCAS results in improved patient survival and future quality of life. Finally, there is clear need to do further research in the Latin American Population.

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In-hospital cardiac arrest epidemiology in a mature rapid response system

Cited by 16 publications

References 13 publications

A rapid response team is associated with reduced overall hospital mortality in a Chinese tertiary hospital: a 9-year cohort study

A rapid response team is associated with reduced overall hospital mortality in a Chinese tertiary hospital: a 9-year cohort study

Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems

Post-cardiac arrest syndrome in adult hospitalized patients

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