Display options
Cite
Mitchell OJL, Motschwiller CW, Horowitz JM, et al. Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals. Crit Care Explor. 2019;1(8):e0031doi: 10.1097/CCE.0000000000000031.
Mitchell, O. J. L., Motschwiller, C. W., Horowitz, J. M., Friedman, O. A., Nichol, G., Evans, L. E., & Mukherjee, V. (2019). Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals. Critical care explorations, 1(8), e0031. https://doi.org/10.1097/CCE.0000000000000031
Mitchell, Oscar J L, et al. "Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals." Critical care explorations vol. 1,8 (2019): e0031. doi: https://doi.org/10.1097/CCE.0000000000000031
Mitchell OJL, Motschwiller CW, Horowitz JM, Friedman OA, Nichol G, Evans LE, Mukherjee V. Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals. Crit Care Explor. 2019 Aug 07;1(8):e0031. doi: 10.1097/CCE.0000000000000031. eCollection 2019 Aug. PMID: 32166272; PMCID: PMC7063949.
Copy Download .nbib Format: NLM
Share it on

Crit Care Explor. 2019 Aug 07;1(8):e0031. doi: 10.1097/CCE.0000000000000031. eCollection 2019 Aug.

Rapid Response and Cardiac Arrest Teams: A Descriptive Analysis of 103 American Hospitals.

Critical care explorations

Oscar J L Mitchell, Caroline W Motschwiller, James M Horowitz, Oren A Friedman, Graham Nichol, Laura E Evans, Vikramjit Mukherjee

Affiliations

  1. Department of Internal Medicine, New York School of Medicine, New York, NY.
  2. Division of Cardiology, New York School of Medicine, New York, NY.
  3. Department of Cardiology, Cedars Sinai, Los Angeles, CA.
  4. Department of Medicine, University of Washington, Seattle, WA.
  5. Department of Emergency Medicine, University of Washington, Seattle, WA.
  6. Medical Director of Critical Care, Bellevue Hospital, New York School of Medicine, New York, NY.
  7. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York School of Medicine, New York, NY.

PMID: 32166272 PMCID: PMC7063949 DOI: 10.1097/CCE.0000000000000031

Abstract

Despite improvements in the management of in-hospital cardiac arrest over the past decade, in-hospital cardiac arrest continues to be associated with poor prognosis. This has led to the development of rapid response systems, hospital-wide efforts to improve patient outcomes by centering on prompt identification of decompensating patients, expert clinical management, and continuous quality improvement of processes of care. The rapid response system may include cardiac arrest teams, which are centered on identification and treatment of patients with in-hospital cardiac arrest. However, few evidence-based guidelines exist to guide the formation of such teams, and the degree of their variation across the United States has not been well described.

DESIGN: Descriptive cross-sectional, internet-based survey.

SETTING: Cohort of preidentified clinicians involved in their hospital's adult rapid response system across the United States.

SUBJECTS: Clinicians who had been identified by study team members using personal and professional contacts over a 7-month period from June 2018 to December 2018.

INTERVENTIONS: An 80-item survey was developed by the investigators. It sought information on the afferent (identification and notification of providers) and efferent (response of providers to patient) limbs of the rapid response system, as well as management of patients post in-hospital cardiac arrest.

MEASUREMENTS AND MAIN RESULTS: One-hundred fourteen surveys were distributed. Of these, 109 (96%) were completed. Six were duplicates and were excluded, leaving a total of 103 surveys from 103 hospitals in 30 states. Seventy-six percent of hospitals were academic, 30% were large hospitals (> 750 inpatient beds), and 58% had large ICUs (> 50 ICU beds). We found wide variation in the structure and function in both the afferent and efferent limbs of the rapid response system. The majority of hospitals had a rapid response team and a cardiac arrest team. Most rapid response teams contained a provider, a critical care nurse, and a respiratory therapist. In hospitals with training programs in internal medicine, anesthesia, emergency medicine, or critical care, 45% of rapid response teams and 75% of cardiac arrest teams were led by trainees, with inconsistent attending presence. Targeted temperature management and coronary catheterization were widely used post in-hospital cardiac arrest, but indications varied considerably.

CONCLUSIONS: We have demonstrated substantial variation in the structure and function of rapid response systems as well as in management of patients during and after in-hospital cardiac arrest.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Keywords: cardiac arrest team; critical care; rapid response system; rapid response team

Conflict of interest statement

Dr. Horowitz received funding from Steering committee for Evaluating the Safety and Efficacy of the Indigo Aspiration System in Acute Pulmonary Embolism (EXTRACT-PE) Clinical Trial with the Penumbra I

References

  1. Qual Saf Health Care. 2004 Aug;13(4):251-4 - PubMed
  2. Ann Emerg Med. 2011 Dec;58(6):509-16 - PubMed
  3. Circulation. 2015 Nov 3;132(18 Suppl 2):S444-64 - PubMed
  4. Resuscitation. 2015 Apr;89:149-54 - PubMed
  5. Ann R Coll Surg Engl. 2006 Oct;88(6):571-5 - PubMed
  6. J Intensive Care Soc. 2015 Aug;16(3):241-243 - PubMed
  7. Crit Care. 2005;9(6):R808-15 - PubMed
  8. J Hosp Med. 2014 Jun;9(6):353-7 - PubMed
  9. Circulation. 2013 Jul 23;128(4):417-35 - PubMed
  10. J Biomed Inform. 2009 Apr;42(2):377-81 - PubMed
  11. Crit Care Med. 2016 Jan;44(1):54-63 - PubMed
  12. Resuscitation. 2013 Apr;84(4):465-70 - PubMed
  13. Med Teach. 2006 Jun;28(4):365-9 - PubMed
  14. QJM. 2001 Oct;94(10):521-6 - PubMed
  15. N Engl J Med. 2011 Jul 14;365(2):139-46 - PubMed
  16. Crit Care. 2015 Jun 12;19:254 - PubMed
  17. Resuscitation. 2010 Jun;81(6):695-702 - PubMed
  18. Resuscitation. 2010 Jan;81(1):31-5 - PubMed
  19. Resuscitation. 2015 Apr;89:123-8 - PubMed
  20. Resuscitation. 2018 Feb;123:58-64 - PubMed
  21. Crit Care Med. 2007 Jul;35(7):1668-72 - PubMed
  22. J Crit Care. 2018 Aug;46:73-78 - PubMed
  23. Resuscitation. 2011 Feb;82(2):150-4 - PubMed
  24. Lancet. 2005 Jun 18-24;365(9477):2091-7 - PubMed
  25. Resuscitation. 2004 Jan;60(1):51-6 - PubMed
  26. Circulation. 2015 Nov 3;132(18 Suppl 2):S397-413 - PubMed
  27. Resuscitation. 2014 Aug;85(8):987-92 - PubMed
  28. Intensive Care Med. 2016 Apr;42(4):593-595 - PubMed
  29. Crit Care Med. 2006 Sep;34(9):2463-78 - PubMed
  30. BMJ. 2007 Dec 8;335(7631):1210-2 - PubMed
  31. BMJ Open. 2019 Mar 8;9(3):e024548 - PubMed
  32. Circulation. 2015 Nov 3;132(18 Suppl 2):S465-82 - PubMed
  33. Circulation. 2018 Jul 10;138(2):154-163 - PubMed
  34. Resuscitation. 1998 Jun;37(3):133-7 - PubMed
  35. Chest. 1990 Dec;98(6):1388-92 - PubMed
  36. Resuscitation. 2013 Aug;84(8):1040-4 - PubMed
  37. Resuscitation. 2015 Oct;95:100-47 - PubMed
  38. ASAIO J. 2017 Jan/Feb;63(1):60-67 - PubMed
  39. Med J Aust. 2003 Sep 15;179(6):283-7 - PubMed
  40. Crit Care Med. 2009 Jan;37(1):148-53 - PubMed
  41. JAMA. 2008 Feb 20;299(7):785-92 - PubMed
  42. Resuscitation. 2004 Sep;62(3):275-82 - PubMed
  43. BMC Emerg Med. 2009 Feb 14;9:3 - PubMed
  44. Crit Care Med. 2014 Jan;42(1):26-30 - PubMed
  45. Crit Care Med. 2016 Feb;44(2):368-74 - PubMed
  46. Resuscitation. 2015 Feb;87:75-80 - PubMed
  47. Acta Anaesthesiol Scand. 2014 Apr;58(4):420-7 - PubMed
  48. Crit Care Med. 2013 Oct;41(10):2284-91 - PubMed
  49. Crit Care Med. 2013 Jun;41(6):1385-95 - PubMed
  50. Crit Care Med. 2017 Nov;45(11):1805-1812 - PubMed

Publication Types