Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results

Tibballs, James; Kinney, Sharon; Duke, Trevor; Oakley, Ed; Hennessy, Martina

doi:10.1136/adc.2004.069401

Cited by 185 publications

(163 citation statements)

References 16 publications

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“…All were conducted in academic teaching hospitals. Two studies 37,38 focused on pediatric inpatients, and the remainder involved hospitalized adults. The RRS intervened for all hospitalized patients in all but 2 studies (1 of which focused on surgical inpatients 33 and the other in which the RRS Elements affecting study internal validity and translatability.…”

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

“…Seven studies 22,23,31,33,34,36,37 that described the team composition used variants of the medical emergency team model, a physician-led team (Table 2). In 6 of these 7 studies, the team included a critical care physician (attending or fellow) and an ICU nurse; in the sole RCT (the MERIT study 36 ), the team structure varied between hospitals, consisting of a nurse and physician from either the emergency department or ICU.…”

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

“…Seven studies [22][23][24]34,[36][37][38] reported enough information to calculate the RRS calling rate (4 studies 24,31,39,40 reported the total number of calls but not the number of admissions, and 2 studies 3,35 did not report either). In these 7 studies, the calling rate varied from 4.5 to 25.8 calls per 1000 admissions.…”

Section: Rrs Usage and Effects On Patient Outcomesmentioning

confidence: 99%

“…Nine studies 3,22,23,33,[35][36][37]39,40 reported the effect of an RRS on inpatient mortality, 9 studies 22,23,31,33,34,[36][37][38]40 reported its effect on cardiopulmonary arrests, and 6 studies 3,22,24,33,36,37 reported its effect on unscheduled ICU admissions. Of these, 7 trials that reported mortality and cardiopulmonary arrests and 6 studies that reported unscheduled ICU admissions supplied sufficient data for meta-analysis.…”

Section: Effects Of Rrs On Clinical Outcomesmentioning

confidence: 99%

“…51 However, published studies generally reported a calling rate of 4-5 calls per 1000 admissions, 22,23,37 with only 1 trial reporting a higher calling rate. 34 A recent commentary 20 and a systematic review of critical care outreach teams 21 both addressed the effectiveness of RRSs.…”

Section: Systematic Review Of Rapid Response Systems / Ranji Et Al 429mentioning

confidence: 99%

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Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

100

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BACKGROUNDA rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster‐randomized trial.PURPOSETo evaluate the effects of RRSs on clinical outcomes through a systematic literature review.DATA SOURCESMEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies.STUDY SELECTIONRandomized and nonrandomized controlled trials, interrupted time series, and before‐after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions.DATA EXTRACTIONTwo authors independently determined study eligibility, abstracted data, and classified study quality.DATA SYNTHESISThirteen studies met inclusion criteria: 1 cluster‐randomized controlled trial (RCT), 1 interrupted time series, and 11 before‐after studies. The RCT showed no effects on any clinical outcome. Before‐after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74‐0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65‐0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before‐after studies.CONCLUSIONSPublished studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before‐after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422–432. © 2007 Society of Hospital Medicine.

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Section: Characteristics Of Included Trialsmentioning

confidence: 99%

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

Section: Rrs Usage and Effects On Patient Outcomesmentioning

confidence: 99%

Section: Effects Of Rrs On Clinical Outcomesmentioning

confidence: 99%

Section: Systematic Review Of Rapid Response Systems / Ranji Et Al 429mentioning

confidence: 99%

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Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

100

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Transition From a Traditional Code Team to a Medical Emergency Team and Categorization of Cardiopulmonary Arrests in a Children's Center

Hunt

Zimmer

Rinke

et al. 2008

Arch Pediatr Adolesc Med

110

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To study the effect of an intervention on prevention of respiratory arrest and cardiopulmonary arrest (CPA) and to characterize ward CPAs by preceding signs and symptoms and initial cardiac rhythm.Design: A before-and-after interventional trial (12 months preintervention and 12 months postintervention).Setting: A tertiary care, academic children's hospital.Participants: Admitted patients who subsequently had either the code team or pediatric medical emergency team (PMET) called or who had a respiratory arrest or CPA on the wards.Intervention: Transition from a traditional code team to a PMET that responds to clinically deteriorating children in noncritical care areas.Outcome Measures: Combined rate of respiratory arrests and CPAs, rate of CPAs, and rate of respiratory ar-rests on the wards and agreement between independent reviewers on categorization of CPAs.

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Reduction in Hospital Mortality Over Time in a Hospital Without a Pediatric Medical Emergency Team

Joffe¹,

Anton²,

Burkholder³

2011

Arch Pediatr Adolesc Med

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Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results

Cited by 185 publications

References 16 publications

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Transition From a Traditional Code Team to a Medical Emergency Team and Categorization of Cardiopulmonary Arrests in a Children's Center

Reduction in Hospital Mortality Over Time in a Hospital Without a Pediatric Medical Emergency Team

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