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Rapid response team activation prior to in-hospital cardiac arrest: Areas for improvements based on a national cohort study
Department of Medicine Solna, Center for Resuscitation Science, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Physiology, Danderyd University Hospital, SE-182 88 Stockholm, Sweden.
Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, SE-118 83 Stockholm, Sweden.
Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, SE-221 84 Lund, Sweden; Department of Anaesthesia and Intensive Care, Kristianstad Hospital, SE-291 89 Kristianstad, Sweden..
Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, SE-118 83 Stockholm, Sweden; Department of Anaesthesia and Intensive Care, Södersjukhuset, SE-118 83 Stockholm, Sweden..
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2023 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 193, article id 109978Article in journal (Refereed) Published
Abstract [en]

Introduction: Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.

Methods: A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.

Results: In all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90-0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001).

Conclusion: IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.

Place, publisher, year, edition, pages
2023. Vol. 193, article id 109978
Keywords [en]
In-hospital cardiac arrest, Medical Emergency Team, National Early Warning Score, Rapid response system, Rapid response team
National Category
Cardiology and Cardiovascular Disease
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-31275DOI: 10.1016/j.resuscitation.2023.109978ISI: 001138879100001Scopus ID: 2-s2.0-85173165981OAI: oai:DiVA.org:hb-31275DiVA, id: diva2:1826271
Available from: 2024-01-11 Created: 2024-01-11 Last updated: 2025-02-10Bibliographically approved

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Herlitz, Johan

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