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Changes in cardiac arrest profiles after the implementation of a Rapid Response Team

OBJECTIVE: To evaluate changes in the characteristics of in-hospital cardiac arrest after the implementation of a Rapid Response Team. METHODS: This was a prospective observational study of in-hospital cardiac arrest that occurred from January 2013 to December 2017. The exclusion criterion was in-ho...

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Autores principales: Viana, Marina Verçoza, Nunes, Diego Silva Leite, Teixeira, Cassiano, Vieira, Silvia Regina Rios, Torres, Grazziela, Brauner, Janete Salles, Müller, Helena, Butelli, Thais Crivellaro Dutra, Boniatti, Marcio Manozzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Associação de Medicina Intensiva Brasileira - AMIB 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075345/
https://www.ncbi.nlm.nih.gov/pubmed/33886858
http://dx.doi.org/10.5935/0103-507X.20210010
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author Viana, Marina Verçoza
Nunes, Diego Silva Leite
Teixeira, Cassiano
Vieira, Silvia Regina Rios
Torres, Grazziela
Brauner, Janete Salles
Müller, Helena
Butelli, Thais Crivellaro Dutra
Boniatti, Marcio Manozzo
author_facet Viana, Marina Verçoza
Nunes, Diego Silva Leite
Teixeira, Cassiano
Vieira, Silvia Regina Rios
Torres, Grazziela
Brauner, Janete Salles
Müller, Helena
Butelli, Thais Crivellaro Dutra
Boniatti, Marcio Manozzo
author_sort Viana, Marina Verçoza
collection PubMed
description OBJECTIVE: To evaluate changes in the characteristics of in-hospital cardiac arrest after the implementation of a Rapid Response Team. METHODS: This was a prospective observational study of in-hospital cardiac arrest that occurred from January 2013 to December 2017. The exclusion criterion was in-hospital cardiac arrest in the intensive care unit, emergency room or operating room. The Rapid Response Team was implemented in July 2014 in the study hospital. Patients were classified into two groups: a Pre-Rapid Response Team (in-hospital cardiac arrest before Rapid Response Team implementation) and a Post-Rapid Response Team (in-hospital cardiac arrest after Rapid Response Team implementation). Patients were followed until hospital discharge or death. RESULTS: We had a total of 308 cardiac arrests (64.6 ± 15.2 years, 60.3% men, 13.9% with initial shockable rhythm). There was a decrease from 4.2 to 2.5 in-hospital cardiac arrest/1000 admissions after implementation of the Rapid Response Team, and we had approximately 124 calls/1000 admissions. Pre-Rapid Response Team cardiac arrest was associated with more hypoxia (29.4 versus 14.3%; p = 0.006) and an altered respiratory rate (14.7 versus 4.2%; p = 0.004) compared with post-Rapid Response Team cardiac arrest. Cardiac arrest due to hypoxia was more common before Rapid Response Team implementation (61.2 versus 38.1%, p < 0.001). In multivariate analysis, return of spontaneous circulation was associated with shockable rhythm (OR 2.97; IC95% 1.04 - 8.43) and witnessed cardiac arrest (OR 2.52; IC95% 1.39 - 4.59) but not with Rapid Response Team implementation (OR 1.40; IC95% 0.70 - 2.81) or premonitory signs (OR 0.71; IC95% 0.39 - 1.28). In multivariate analysis, in-hospital mortality was associated with non-shockable rhythm (OR 5.34; IC95% 2.28 - 12.53) and age (OR 1.03; IC95% 1.01 - 1.05) but not with Rapid Response Team implementation (OR 0.89; IC95% 0.40 - 2.02). CONCLUSION: Even though Rapid Response Team implementation is associated with a reduction in in-hospital cardiac arrest, it was not associated with the mortality of in-hospital cardiac arrest victims. A significant decrease in cardiac arrests due to respiratory causes was noted after Rapid Response Team implementation.
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spelling pubmed-80753452021-04-29 Changes in cardiac arrest profiles after the implementation of a Rapid Response Team Viana, Marina Verçoza Nunes, Diego Silva Leite Teixeira, Cassiano Vieira, Silvia Regina Rios Torres, Grazziela Brauner, Janete Salles Müller, Helena Butelli, Thais Crivellaro Dutra Boniatti, Marcio Manozzo Rev Bras Ter Intensiva Original Article OBJECTIVE: To evaluate changes in the characteristics of in-hospital cardiac arrest after the implementation of a Rapid Response Team. METHODS: This was a prospective observational study of in-hospital cardiac arrest that occurred from January 2013 to December 2017. The exclusion criterion was in-hospital cardiac arrest in the intensive care unit, emergency room or operating room. The Rapid Response Team was implemented in July 2014 in the study hospital. Patients were classified into two groups: a Pre-Rapid Response Team (in-hospital cardiac arrest before Rapid Response Team implementation) and a Post-Rapid Response Team (in-hospital cardiac arrest after Rapid Response Team implementation). Patients were followed until hospital discharge or death. RESULTS: We had a total of 308 cardiac arrests (64.6 ± 15.2 years, 60.3% men, 13.9% with initial shockable rhythm). There was a decrease from 4.2 to 2.5 in-hospital cardiac arrest/1000 admissions after implementation of the Rapid Response Team, and we had approximately 124 calls/1000 admissions. Pre-Rapid Response Team cardiac arrest was associated with more hypoxia (29.4 versus 14.3%; p = 0.006) and an altered respiratory rate (14.7 versus 4.2%; p = 0.004) compared with post-Rapid Response Team cardiac arrest. Cardiac arrest due to hypoxia was more common before Rapid Response Team implementation (61.2 versus 38.1%, p < 0.001). In multivariate analysis, return of spontaneous circulation was associated with shockable rhythm (OR 2.97; IC95% 1.04 - 8.43) and witnessed cardiac arrest (OR 2.52; IC95% 1.39 - 4.59) but not with Rapid Response Team implementation (OR 1.40; IC95% 0.70 - 2.81) or premonitory signs (OR 0.71; IC95% 0.39 - 1.28). In multivariate analysis, in-hospital mortality was associated with non-shockable rhythm (OR 5.34; IC95% 2.28 - 12.53) and age (OR 1.03; IC95% 1.01 - 1.05) but not with Rapid Response Team implementation (OR 0.89; IC95% 0.40 - 2.02). CONCLUSION: Even though Rapid Response Team implementation is associated with a reduction in in-hospital cardiac arrest, it was not associated with the mortality of in-hospital cardiac arrest victims. A significant decrease in cardiac arrests due to respiratory causes was noted after Rapid Response Team implementation. Associação de Medicina Intensiva Brasileira - AMIB 2021 /pmc/articles/PMC8075345/ /pubmed/33886858 http://dx.doi.org/10.5935/0103-507X.20210010 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Viana, Marina Verçoza
Nunes, Diego Silva Leite
Teixeira, Cassiano
Vieira, Silvia Regina Rios
Torres, Grazziela
Brauner, Janete Salles
Müller, Helena
Butelli, Thais Crivellaro Dutra
Boniatti, Marcio Manozzo
Changes in cardiac arrest profiles after the implementation of a Rapid Response Team
title Changes in cardiac arrest profiles after the implementation of a Rapid Response Team
title_full Changes in cardiac arrest profiles after the implementation of a Rapid Response Team
title_fullStr Changes in cardiac arrest profiles after the implementation of a Rapid Response Team
title_full_unstemmed Changes in cardiac arrest profiles after the implementation of a Rapid Response Team
title_short Changes in cardiac arrest profiles after the implementation of a Rapid Response Team
title_sort changes in cardiac arrest profiles after the implementation of a rapid response team
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075345/
https://www.ncbi.nlm.nih.gov/pubmed/33886858
http://dx.doi.org/10.5935/0103-507X.20210010
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