Abstract 266: Cardiac Arrest in the Intensive Care Unit: A Preventable Problem
Introduction: Cardiac arrest occurring in the ICU is a relatively common and highly morbid event. Due to continuous monitoring, low nurse-to-patient ratios and close proximity of the physician team, ICU arrests are often considered an inevitable result of the underlying disease process. We sought to explore the preventability of ICU arrests and identify targets for future intervention. Methods: This was a single center, prospective study. For each ICU arrest occurring between 8/2017-3/2018, the clinical team (attending physician, trainee[s] and bedside nurse) were surveyed regarding arrest preventability. An expert team of critical care physicians and nurses also reviewed each arrest, providing a score from 0 (not at all preventable) to 5 (completely preventable). Median preventability scores were calculated and themes of preventability identified. Results: We reviewed 39 ICU arrests. Each was reviewed by a median of 7 (6, 8) expert reviewers and 88/159 (55%) surveys were returned. The median preventability rating was 1 (IQR: 0, 2) in the prospective surveys and 1 (0, 2.5) in the expert review. In the expert review, there were 10 (26%) arrests with a median score of >2. Common themes included inadequate response to worsening shock, delays in intubation, failure to obtain help from the senior physician and use of narcotics/anxiolytics for agitation without recognizing or addressing clinical worsening (see Figure). When asked, ‘did you observe/were you informed of any clinical changes preceding the cardiac arrest?’—nurses and trainees responded affirmatively in 74% and 79% of cases, compared to 46% of cases for attending physicians (p=0.03). Conclusions: Cardiac arrests in the ICU may be preventable. Nurses and trainees indicated awareness of acute deterioration more often than attending physicians, highlighting an opportunity for improvement. Several clinical themes of preventability were identified which may help inform future data-driven interventions.