Nurmi J, Harjola V P, Nolan J, Castrén M
Department of Anesthesiology and Intensive Care Medicine, Uusimaa Emergency Medical Services, Helsinki University Hospital, FI-00100 Helsinki, Finland.
Acta Anaesthesiol Scand. 2005 May;49(5):702-6. doi: 10.1111/j.1399-6576.2005.00679.x.
The Medical Emergency Team (MET) has evolved in some hospitals as a means of delivering effective treatment early enough to prevent cardiac arrests. Our aim was to analyze the effectiveness of observation practice to detect abnormalities in vital signs prior to cardiac arrest and to determine the need for a MET system in Finnish hospitals.
The charts of patients who suffered cardiac arrest during 18 months in four hospitals were reviewed. The vital signs, symptoms and interventions during 8 h prior to arrest were recorded and analyzed against trigger criteria of the MET.
During the study period, 110 patients suffered cardiac arrest in hospitals, and 56 (51%) of the arrests occurred on the wards. Of those patients, 30 (54%) had an abnormal vital sign fulfilling the MET criteria, documented on average 3.8 h prior to the arrest. During this period, 13 patients did not receive any intervention (e.g. supplemental oxygen or medication), eight received intervention within 1 h and nine received intervention after more than 1 h. Response to the first intervention was not attained in any patient; nevertheless re-interventions took place in one patient only.
Significant physiological deterioration seems to be common in the hours before a cardiac arrest on the wards of Finnish hospitals, suggesting that implementation of a MET-system may be worthwhile. However, the practice of vital sign observation by the nursing staff should be improved before maximal benefit of a MET can be achieved.
在一些医院，医疗急救团队（MET）已经发展成为一种尽早提供有效治疗以预防心脏骤停的手段。我们的目的是分析观察实践在心脏骤停前检测生命体征异常的有效性，并确定芬兰医院对MET系统的需求。
回顾了四家医院18个月内发生心脏骤停患者的病历。记录并根据MET的触发标准分析了心脏骤停前8小时内的生命体征、症状和干预措施。
在研究期间，110名患者在医院发生心脏骤停，其中56例（51%）发生在病房。在这些患者中，30例（54%）有符合MET标准的生命体征异常，平均在心脏骤停前3.8小时有记录。在此期间，13例患者未接受任何干预（如补充氧气或药物治疗），8例在1小时内接受了干预，9例在1小时后接受了干预。没有患者对首次干预有反应；然而，只有1例患者进行了再次干预。
在芬兰医院的病房里，心脏骤停前数小时内明显的生理恶化似乎很常见，这表明实施MET系统可能是值得的。然而，在实现MET的最大效益之前，护理人员对生命体征的观察实践应该得到改善。
