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Ramez Nassri ACF Abstract FY10

"Clinical Antecedents to In-Hospital Cardiopulmonary Arrest After Institution of a Rapid Response Team"

Conference Name: American Academy of Physician Assistants 38th Annual PA Conference - Impact 2010

Purpose: The concept of the Rapid Response Team (RRT) originated from the observation that patients receiving care in hospitals often had physiological deterioration several hours prior to developing a cardiac or respiratory arrest.1, 2  Based on these findings, it was concluded that if recognition of physiological instability in a non-critical care setting occurred, then an appropriate health care provider could be dispatched to the bedside and intervene early enough to prevent a critical event.3 In most hospitals, the RRT is composed of healthcare professionals (nurses, physicians, PAs, respiratory therapists, and other providers) who are called to respond to established criteria which indicate physiological instability in a patient. The purpose of this study is to analyze the 24 hour time period prior to a cardiopulmonary arrest in order to evaluate the utilization of the RRT and to determine if there were clinical antecedents which may indicate physiologic demise.

Method: A retrospective case control design was used in this study. All subjects were identified from the ICD-9 diagnosis code of cardiopulmonary arrest who were hospitalized between October 1st, 2007 and September 30th, 2008.  Patients less than 18 years of age and those patients admitted to an intensive care unit were excluded from the study.  A data collection tool was utilized to document demographic information, laboratory values, cardiovascular or respiratory events, central nervous system and renal parameters 24 hours prior to the arrest.

Results: 101 cardiopulmonary arrests were identified within the designated time period with an age range of 18 to 97 years of age (mean 66 years old).  The type of arrests includes respiratory arrest (29%), cardiac arrest (40%), cardiac and respiratory arrest (19%) and other (12%)  Twenty four hours prior to the code, the RRT was called upon in 10 cases for the following reasons:  unresponsive patients and altered mental status.  Physiologic parameters were analyzed to determine if there were predictive changes in the prior 24 hours which could have identified the need to call the RRT and thus prevent the impending arrest. A specific physiologic parameter was not identified as a predictor of demise in the subjects.  However, there were several inconsistent physiologic changes that were identified.  Those changes included: mental status changes in 17 subjects, documented arrthymias in 20 subjects, change in speaking in 10 subjects, and chest pain in 10 subjects.

Conclusions: This study was performed in order to determine if there were any predictors to an impending cardiopulmonary arrest in subjects hospitalized in a non-critical care unit in an acute care setting.  Only 10 of the subjects had a documented RRT call within the preceding 24 hours with numerous patients having physiologic changes which could have warranted the use of the RRT.  As a result of these findings, further studies have been proposed to examine the role of the RRT and the effectiveness of communication between primary care givers and the RRT.

Presenters (No lead presenter):

David Patel PA-S

Ramez Nassri PA-S

Briana Loney PA-S

Theresa Bacon-Baguley PhD, RN