scholarly journals Outcome among patients suffering from in-hospital cardiac arrest

2014 ◽  
Vol 142 (3-4) ◽  
pp. 170-177
Author(s):  
Sladjana Trpkovic ◽  
Aleksandar Pavlovic ◽  
Vesna Bumbasirevic ◽  
Ana Sekulic ◽  
Biljana Milicic
Keyword(s):  
Cardiac Arrest ◽  
Continuous Monitoring ◽  
Life Support ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Hospital Treatment ◽  
Time Of Arrival ◽  
Technical Equipment ◽  
Emergency Team ◽  
Factors Associated

Introduction. In relation to pre-hospital treatment of patients with cardiac arrest (CA) in the field where resuscitation is often started by nonprofessionals, resuscitation in hospital is most commonly performed by well-trained personnel. Objective. The aim was to define the factors associated with an improved outcome among patients suffering from the inhospital CA (IHCA). Methods. The prospective study included a total of 100 patients in the Emergency Center over two-year period. The patterns by the Utstein-Style guidelines recorded the following: age, sex, reason for hospital admission, comorbidity, cause and origin of CA, continuous monitoring, time of arrival of the medical emergency team and time of delivery of the first defibrillation shock (DC). Results. Most patients (61%) had cardiac etiology. Return of spontaneous circulation (ROSC) was achieved in 58% of patients. ROSC was more frequently achieved in younger patients (57.69?11.37), (p<0.05), non-surgical patients (76.1%), (p<0.01) and in patients who were in continuous monitoring (66.7%) (p<0.05). The outcome of CPR was significantly better in patients who received advanced life support (ALS) (76.6%) (p<0.01). Time until the delivery of the first DC shock was significantly shorter in patients who achieved ROSC (1.67?1.13 min), (p<0.01). A total of 5% of IHCA patients survived to hospital discharge. Conclusion. In our study, the outcome of CPR was better in patients who were younger and with non-surgical diseases, which are prognostic factors that we cannot control. Factors associated with better outcome of IHCA patients were: continuous monitoring, shorter time until the delivery of the first DC and ALS. This means that better education of medical staff, better organization and up-to-dated technical equipment are needed.

The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team

Resuscitation ◽  
2002 ◽  
Vol 54 (2) ◽  
pp. 125-131 ◽  
Author(s):  
Timothy J. Hodgetts ◽  
Gary Kenward ◽  
Ioannis G. Vlachonikolis ◽  
Susan Payne ◽  
Nicolas Castle
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team ◽  
Activation Criteria

Abstract 220: Missed Opportunity for Medical Emergency Team Activation in Pediatric In-Hospital Cardiac Arrest

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Natalie Jayaram ◽  
Maya L Chan ◽  
Fengming Tang ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Medical Emergency Team ◽  
Vital Signs ◽  
National Registry ◽  
Medical Emergency ◽  
Missed Opportunities ◽  
Emergency Team ◽  
Variable Success ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Prior studies of Medical Emergency Teams (METs) in pediatric hospitals have shown inconsistent results in terms of their ability to improve outcomes. Whether the variable success is due to differential utilization of METs among hospitals is unknown. Methods: Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children (age <18 years) with an in-hospital cardiac arrest (IHCA) on the general inpatient or telemetry floors from 2007 to 2014. In cases of IHCA where MET evaluation did not occur, we examined the frequency of “missed” opportunities for activation of the MET based upon the presence of one or more abnormal vital signs. We also examined the variability in utilization of the MET among those hospitals with at least ten cases of IHCA. Results: Of 215 children from 23 hospitals sustaining an IHCA, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to IHCA were older (6.8 ± 6.5 vs. 3.1 ± 4.7, p < 0.001) and were more likely to have metabolic/electrolyte abnormalities (9/48 [18.8%] vs. 9/167 [5.4%], p=0.006), sepsis (8/48 [16.7%] vs. 8/167 [4.8%], p=0.01), or malignancy (11/48 [22.9%] vs. 9/167 [5.4%], p<0.001) at the time of their IHCA. Hospital utilization of the MET varied substantially (median 20%; inter-quartile range [IQR]: 3.4%-29.8%; range: 0%-36.4%). Among patients who did not have a MET called prior to their IHCA, 78/141 (55.3%) had at least one abnormal vital sign that should have triggered a MET. Conclusion: In a large, national registry, we found that the majority of pediatric IHCA cases are not preceded by a MET evaluation despite meeting criteria that should have triggered a MET. Improved utilization of the MET by all hospitals could lead to fewer pediatric IHCA and improved outcomes following pediatric IHCA.

Factors associated with delayed activation of medical emergency team and excess mortality: An Utstein-style analysis

Resuscitation ◽  
2013 ◽  
Vol 84 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Joonas Tirkkonen ◽  
Jari Ylä-Mattila ◽  
Klaus T. Olkkola ◽  
Heini Huhtala ◽  
Jyrki Tenhunen ◽  
...  
Keyword(s):  
Excess Mortality ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Style Analysis ◽  
Emergency Team ◽  
Factors Associated ◽  
Utstein Style

scholarly journals Pediatric Pharmacists' Participation in Cardiopulmonary Resuscitation Events

2018 ◽  
Vol 23 (6) ◽  
pp. 502-506
Author(s):  
Peter N. Johnson ◽  
Amy Mitchell-Van Steele ◽  
Amy L. Nguyen ◽  
Sylvia Stoffella ◽  
J. Maria Whitmore ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Basic Life Support ◽  
Life Support ◽  
Training Programs ◽  
Medical Emergency Team ◽  
Advanced Life Support ◽  
Advanced Cardiac Life Support ◽  
Medical Emergency ◽  
Emergency Team ◽  
The Impact

The Pediatric Pharmacy Advocacy Group (PPAG) understands the dilemma and varying factors that many institutions face concerning the routine participation of pharmacists in emergency resuscitation events. Acknowledging these obstacles, the PPAG encourages all institutions to strongly consider creating, adopting, and upholding policies to address pharmacists' participation in cardiopulmonary resuscitation (CPR) as evidenced by the impact pharmacist participation has shown on the reduction of hospital medication error and mortality rates in children. The PPAG advocates that pharmacists be actively involved in the institution's CPR, medical emergency team committees, and preparation of emergency drug kits and resuscitation trays. The PPAG advocates that all institutions requiring a pharmacist's participation in CPR events consider adoption of preparatory training programs. Although the PPAG does not advocate any one specific program, consideration should be taken to ensure that pharmacists are educated on the pharmacotherapy of drugs used in the CPR process, including but not limited to basic life support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support algorithms; medication preparation and administration guidelines; medication compatibility; recommended dosing for emergency medications; and familiarity with the institutional emergency cart.

Abstract 75: Electronic Integrated Monitoring of Medical Emergency Team Calls to a Step Down Unit

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Marilyn Hravnak ◽  
Leslie Edwards ◽  
Molly Foster-Heasley ◽  
Amy Clontz ◽  
Cynthia Valenta ◽  
...  
Keyword(s):  
Continuous Monitoring ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Status Change ◽  
Peripheral Oxygen Saturation ◽  
Integrated Monitoring ◽  
Emergency Team ◽  
Physiological Variables ◽  
Patient Deterioration ◽  
Step Down

Purpose: Early discharge from intensive care units (ICU) to lower acuity monitoring units (step-down units or SDU) is increasing to improve care throughput. However, the ability of minimally invasive monitoring via electronic integrated monitoring systems (IMS) in SDUs to identify cardiopulmonary deterioration in order to activate Medical Emergency Team (MET) response is unknown. We evaluated the ability of an IMS index value to detect clinically significant events which might trigger activation of the MET earlier than called. Methods: Patients were monitored on a 24 bed trauma SDU according to prevailing policy and bedside decision making. An IMS (BioSign TM ) was inserted into the monitoring system and IMS data were collected in a blinded fashion for 8 weeks from all patients. The IMS uses 4 parameters (heart rate [HR], respiratory rate [RR], blood pressure [BP], peripheral oxygen saturation [SpO 2 ]) to develop a single neural networked signal known as the BioSign Index (BSI). Data were analyzed for patient deterioration according to both BSI trigger value and local MET criteria (DeVita, Qual Safety Health Care 2004). Results: Data from 333 patient admissions were evaluated reflecting 18,692 hours of continuous monitoring. SpO 2 monitoring data were absent in 38.5% of monitored hours, despite being mandatory. Most patients were stable throughout their SDU stay. MET activation occurred on 10 occasions (4 respiratory cause [2 SpO 2 , 2 SpO 2 +RR], 2 cardiac (BP), 1 mixed respiratory + cardiac, and 3 other (1 chest pain, 2 acute mental status change). All 7 MET events of respiratory and/or cardiac cause were detected by BSI in advance (mean advanced detection time prior to MET activation was 6.33 hours). Cardiopulmonary deterioration was generally characterized by progressive increases in BSI over time, not step increases. Conclusion : In this population, cardiopulmonary deterioration requiring MET activation was uncommon but always preceded by IMS index elevations which would have alerted the nursing staff in advance. Continuous monitoring of physiological variables may be augmented by integrating information from multiple parameters to create a new variable. The new index parameter may detect patient deterioration earlier than single parameter monitoring.

Outcomes following changing from a two-tiered to a three-tiered hospital rapid response system

2019 ◽  
Vol 43 (2) ◽  
pp. 178
Author(s):  
The Concord Medical Emergency Team Study Investigators
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Structured Interviews ◽  
Emergency Team ◽  
Response System

Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality. Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P&lt;0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward. Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown. What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes. What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.

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