The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team
Introduction
Two-thirds of in-hospital cardiac arrests are potentially avoidable [1]. Poor survival [2] and international recognition that cardiac arrest is frequently avoidable [3], [4], [5], [6] has resulted in the development of acute response teams that aim to avert cardiac arrest [7], [8], [9], [10]. These teams predominantly rely upon predetermined changes in physiological parameters to trigger a clinical response. United Kingdom central government supports the extension of acute response teams as part of its prevention of illness strategy [11], [12], [13].
The root scoring system for the MET from Australia was developed empirically, and has been subject to further empirical modifications in Australia [7], [8] and the UK [9], [10]. The development of these systems has been related to the prevalence of individual abnormal signs without knowing their predictive value for cardiac arrest [14], [15]. In the simpler systems, where no methodology is described, they are presumed to be entirely experience based. Failure to validate existing MET scoring systems has been identified as a weakness [14], [16].
Section snippets
Setting
An acute 700 bed district general hospital with 32 348 adult admissions in 1999 and a catchment population of around 365 000.
Definitions
Adult patients were defined as>16 years of age.
Patients and case-note analysis
About 118 consecutive adult patients suffering primary cardiac arrest where resuscitation was attempted and a comparative sample formed from the chart records of 132 non-arrest adult patients present on acute wards on the day of investigation. Chart records of controls were chosen randomly by stratified randomisation
Results
The two groups were of comparable age (cardiac arrest patients median age 72.7 years, range 22–93 years; non-arrest patients median age 69.2 years, range 18–98 years) and gender distribution (proportions of females 46.6% for cases and 49.2% for controls).
Discussion
This study represents the first evidence-based approach to providing activation criteria for an acute response team rather than relying upon extrapolations from empirical models. The clinical antecedents to fatal deterioration identified in this study are consistent with the findings of other studies. The key difference is the quantification of these antecedents into a structured and weighted response. Assessment of sensitivity and specificity confirms the need for a graded clinical response
Conclusion
This study has quantified the importance of new symptoms, physiological changes and biochemical changes as risk factors for in-hospital cardiac arrest. A graduated clinical response begins to address the concerns regarding sensitivity and specificity of scoring systems. Activation criteria that quantify deterioration and provide a graduated and appropriate clinical response are a risk management tool that will assist in managing system failures within our hospitals.
Acknowledgements
Colonel N Ineson and Dr L Shaikh are thanked for their review of cardiac arrest cases and activation criteria. This research project is funded for 2 years from November 1999 by the Defence Secondary Care Agency's Clinical Effectiveness budget.
References (29)
- et al.
Can some in-hospital cardio-respiratory arrests be prevented
Resuscitation
(1998) - et al.
Clinical antecedents to in-hospital cardiopulmonary arrest
Chest
(1990) - et al.
Pre-arrest morbidity and other correlates of survival after in-hospital cardiopulmonary arrest
Am. J. Med.
(1989) - Hodgetts TJ, Kenward G, Vlachonikolis I, Payne S, Castle N, Crouch R, Ineson N, Shaikh L. Incidence, location and...
- et al.
Outcome after cardiac arrest in adults in UK hospitals: effect of the guidelines
Resuscitation
(1997) - et al.
Medical patients at high risk for catastrophic deterioration
Crit. Care Med.
(1987) - et al.
Developing strategies to prevent in-hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event
Crit. Care Med.
(1994) - et al.
Discharge decision-making in a medical ICU: characteristics of unexpected readmission
Crit. Care Med.
(1983) - et al.
The medical emergency team: a new strategy to identify and intervene in high-risk patients
Clin. Int. Care
(1995) - et al.
The medical emergency team (MET): a model for the district general hospital
Aust. New Zealand J. Med.
(1998)
Early warning scoring system for detecting developing critical illness
Clin. Int. Care
The patient-at-risk team: identifying and managing seriously ill ward patients
Anaesthesia
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