PURPOSE:Physiologic deterioration is expected to precede most cardiopulmonary arrests. Investigators have proposed an early warning system coupled with a “Rapid Response Team” to help prevent deterioration to cardiac arrest. However a “Rapid Response Team” is an addition to already existing services. It requires personnel, logistic support and additionally strains resources. It is not yet clear whether this intervention is necessary in teaching hospitals. We carried out this study to determine the incidence of early physiological deterioration in hospitalized patients progressing to cardiopulmonary arrest and to determine a need for a “Rapid Response Team” in our facility.
METHODS:Medical records of patients who suffered in- hospital cardiorespiratory arrest during the period January - December 2006 were reviewed for serial vital signs, percent oxygen saturation, Glasgow Coma Scale and arterial blood gases for the 24 hours prior to arrest. Only adult inpatients who deteriorated to cardiopulmonary arrest and underwent CPR were included. Patients with a do-not-resuscitate (DNR) status or having an incomplete data set were excluded.
RESULTS:222 cardiopulmonary arrests occurred in the study period. statistically significant deteriorating trends in physiological variables at 24 hours, 12 hours, 6 hours, 2 hours and upto 1 hour prior to cardiopulmonary arrest were observed; mean systolic BP[117.5 mmHg at 24 hours, 98.4 mmHg at 1 hour, p value 0.000], diastolic BP[71 mmHg at 24 hours, 58 mmHg at 1 hour, p value 0.002], Glasgow Coma Score [11 at 24 hours, 6 at 1 hour, p value 0.000], peripheral oxygen saturations [96% at 24 hours, 90% at 1 hour, p value 0.000], and respiratory rates [23 breaths/minute at 24 hours, 27 breaths/minute at 1 hour, p value 0.001] .
CONCLUSION:Despite the existence of training programs; continued physiological deterioration as measured by usual monitoring mechanisms is not being recognized.
CLINICAL IMPLICATIONS:There is a definite role of an early warning system and a “Rapid Response Team” in teaching hospitals.
DISCLOSURE:Nawal Salahuddin, No Financial Disclosure Information; No Product/Research Disclosure Information