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.
Keywords: cardiac arrest team; critical care; rapid response system; rapid response team.
Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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 Indigo Aspiration System. Dr. Friedman received funding from Bristol Myers Squibb speaker’s bureau. Dr. Nichol received funding from National Heart Lung Blood Institute, Bethesda, MD, Pragmatic Airway Resuscitation Trial (PART), UH2 HL125163-03, Co-I, Modest; National Heart Lung Blood Institute, Bethesda, MD, Intravenous Sodium Nitrite as Therapy for Cardiac Arrest Pilot Trial (SNOCAT) UH2 HL129722-02, Co-I, Modest; Department of Defense, Washington, DC. Translating Military Simulation-based Trauma Team Research into Outcomes: LEADing Effective Resuscitations (LEADER), Co-I, Modest; Abiomed, Danvers, MA. Program to Identify Cardiogenic Shock Early (PRIME). PI, Modest; GE Healthcare, Chicago, IL. Very Early Identification of Shock by Ultrasound Exam (VENUE) PI, Modest; ZOLL Circulation, Sunnyvale, CA. STEMI Cool Pilot Trial to Assess Cooling as an Adjunctive Therapy to PCI In Patients With Acute MI (STEMI Cool) U.S. Pilot Trial, PI, Modest; and ZOLL Medical, Chelmsford, MA. Cardiopulmonary resuscitation process versus outcome, PI, Modest. Dr. Evans consulting for the Healthcare Association of New York State on Sepsis Quality Improvement. Dr. Mukherjee consult for 2nd MD, an online physician consultation enterprise. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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