Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania, United States.
Resuscitation. 2011 Apr;82(4):415-8. doi: 10.1016/j.resuscitation.2010.12.005. Epub 2011 Jan 16.
The merit of rapid response systems (RRSs) remains controversial. A tailored approach to specific groups may increase the efficacy of these teams. The purpose of this study was to compare differences in triggers for RRS activation, interventions, and outcomes in patients on medical and surgical services.
A retrospective review RRS events was performed. The incidence of out of ICU cardiac arrests and hospital mortality were compared 2 years prior to and following RRS implementation. Call trigger, interventions, and disposition between medical and surgical patients were compared over a 15 month period.
Out of ICU cardiac arrest was significantly more prevalent in the medical group both before and after implementation of RRS. The out of ICU cardiac arrest rate decreased 32% in the surgical group (p=0.05) but hospital mortality did not change. Out of ICU cardiac arrest decreased 40% in the medical group (p<0.001) and hospital mortality decreased 25% (p<0.001) following RRS implementation. There were 1082 RRS activations, 286 surgical and 796 medical. Surgical patients were more likely to have received sedation within 24 h of evaluation (14% vs. 4%, p<0.001). The majority of patients in both cohorts were discharged alive.
Implementation of a RRS had greater impact on reduction of out of ICU cardiac arrest and mortality in medical inpatients. Triggers for activation and interventions were similar between groups; however, surgical patients demonstrated substantial risk for decompensation within the first 24 h following operation. More research is needed to evaluate the disproportionate benefit observed between cohorts.
快速反应系统（RRS）的优势仍存在争议。针对特定人群采用针对性方法可能会提高这些团队的效率。本研究旨在比较医疗和外科服务患者的 RRS 激活、干预和结局的差异。
对 RRS 事件进行回顾性分析。比较 RRS 实施前 2 年和实施后 ICU 外心脏骤停的发生率和医院死亡率。在 15 个月的时间内比较了内科和外科患者的呼叫触发、干预和处理情况。
在 RRS 实施前后，内科患者 ICU 外心脏骤停的发生率均显著更高。外科组的 ICU 外心脏骤停发生率下降了 32%（p=0.05），但医院死亡率没有变化。内科组的 ICU 外心脏骤停发生率下降了 40%（p<0.001），医院死亡率下降了 25%（p<0.001）。共激活了 1082 次 RRS，其中 286 次为外科，796 次为内科。外科患者在评估后 24 小时内接受镇静治疗的可能性更大（14%比 4%，p<0.001）。两个队列中的大多数患者都活着出院。
RRS 的实施对降低内科住院患者 ICU 外心脏骤停和死亡率的影响更大。两组的激活和干预措施相似，但外科患者在手术后的前 24 小时内有明显的失代偿风险。需要进一步研究来评估两个队列之间观察到的不成比例的获益。
