Clinical Antecedents to In-Hospital Cardiopulmonary Arrest

University of Miami, كورال غيبلز، فلوريدا, Florida, United States
Chest (Impact Factor: 7.48). 01/1991; 98(6):1388-92. DOI: 10.1378/chest.98.6.1388
Source: PubMed


While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161 +/- 26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29 +/- 1 breaths per minute. The prognoses of patients' underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial.

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    • "Therefore, we hypothesize that the ICU nurses' perspective is currently overshadowing the ACU nurses' one in the literature . This might be explained by the origin of the interest in this issue, which was raised by studies conducted by medical researchers of patient trajectory prior to ICU admission or cardiac arrest (Schein et al., 1990; Goldhill et al., 1999; Hodgetts et al., 2002). Questioning the quality of care of deteriorating patients on ACU seems to have brought the focus solely on this environment . "
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    ABSTRACT: AimTo explore the variations between acute care and intensive care nurses' understanding of patient deterioration according to their use of this term in published literature.Background Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses' help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains.DesignDimensional analysis was used as a framework to analyze papers retrieved in a nursing-focused database.MethodA thematic analysis of 34 papers (2002–2012) depicting acute care and intensive care unit nurses' perspectives on patient deterioration was conducted.FindingsNo explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses' accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored.Conclusions From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology towards critical illness. Contextual factors relating to acute care units (ACU) appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modelling the concept of patient deterioration, which could be specific to ACU.Relevance to clinical practiceThe findings suggest that it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issue.
    Nursing in Critical Care 09/2014; DOI:10.1111/nicc.12114 · 0.65 Impact Factor
    • "Cardiopulmonary arrests and its attendant mortality in patients coming to or admitted in hospitals are common and their delayed intervention is associated with lower survival rate and poor neurological outcome.[6] It has been observed that almost half of the cases of cardiopulmonary arrests are preceded by deterioration in vital signs or other clinical indices 6-8 h prior to arrest.[78910] Therefore, early recognition of activating triggers and generating codes may provide a window of opportunity for averting cardiopulmonary arrest and its attendant mortality.[11] "
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    ABSTRACT: Rapid response team (RRT) has been implemented in developed countries with the aim of early recognition and response to critical care triggers for the better patient outcome. However, the data concerning their efficacy is hardly available until date from Indian subcontinent. To evaluate the impact of RRT implementation on patient outcome during medical emergencies. Retrospective observational study of RRT records of in-bed patients of super specialty academic teaching hospital. RRT record forms during the first half of the year from January 2012 to June 2012 were included for all inpatients and out-patients irrespective of their age, gender and diseases profile after their inclusion in the system. Outcomes such as patient stayed in the room, patient transfer to intensive care unit (ICU), patient discharge and generation of code blue event, mortality and length of stay in hospital/ICU were measured. Descriptive analysis was performed with the help of statistical software STATA 9.0 and R 2.13.2 (StataCorp LP, Lakeway Drive College Station, Texas, USA). Analysis of 41 RRT calls showed decreased code blue calls by 2.44% and decrease in mortality by 4.88%. Average length of stay in ICU and hospital post RRT assistance for patients was 2.55 and 6.95 days respectively. Conversely percentage of patients requiring a higher level of care was more (75.61%) than those who stayed in their rooms/wards (24.39%). Implementation of RRT in this hospital was associated with reduced code blue events and its attendant mortality outside the ICU settings. However, more number of patient requiring higher levels of care delineates the need for a larger evidence based medicine study.
    03/2014; 4(1):3-9. DOI:10.4103/2229-5151.128005
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    • "Screening is the first step in triggering an RRS, but there are many barriers to calling an RRS team to care for at-risk patients, such as disengagement between the doctors and nurses, professional resistance, and inadequate knowledge for recognizing at-risk patients (1). In previous studies, 20%-25% of patients at risk were not identified due to insufficient recognition of the patient warning signs by doctors and nurses (5, 6). It has been reported that 3.7%-4.0% of hospitalized patients show critical symptoms and signs and that the rate of adverse events due to negligence is 0.8%-1.0%. "
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    ABSTRACT: The rapid response system (RRS) is an innovative system designed for in-hospital, at-risk patients but underutilization of the RRS generally results in unexpected cardiopulmonary arrests. We implemented an extended RRS (E-RRS) that was triggered by actively screening at-risk patients prior to calls from primary medical attendants. These patients were identified from laboratory data, emergency consults, and step-down units. A four-member rapid response team was assembled that included an ICU staff, and the team visited the patients more than twice per day for evaluation, triage, and treatment of the patients with evidence of acute physiological decline. The goal was to provide this treatment before the team received a call from the patient's primary physician. We sought to describe the effectiveness of the E-RRS at preventing sudden and unexpected arrests and in-hospital mortality. Over the 1-yr intervention period, 2,722 patients were screened by the E-RRS program from 28,661 admissions. There were a total of 1,996 E-RRS activations of simple consultations for invasive procedures. After E-RRS implementation, the mean hospital code rate decreased by 31.1% and the mean in-hospital mortality rate was reduced by 15.3%. In conclusion, the implementation of E-RRS is associated with a reduction in the in-hospital code and mortality rates. Graphical Abstract
    Journal of Korean medical science 03/2014; 29(3):423-30. DOI:10.3346/jkms.2014.29.3.423 · 1.27 Impact Factor
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