快速反应小组对降低意外心脏骤停发生率和死亡率的疗效。

Efficacy of a rapid response team on reducing the incidence and mortality of unexpected cardiac arrests.

作者信息

Sabahi Majid, Fanaei Seyed Ahmad, Ziaee Seyed Ali, Falsafi Farokh Sadat

机构信息

Faculty of University of Sunny Brook, CA ATLS Instructor by American College of Surgeons, Toronto, Canada ; Department of Emergency Medicine, Atieh Hospital, Tehran, IR Iran.

Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

出版信息

Trauma Mon. 2012 Summer;17(2):270-4. doi: 10.5812/traumamon.4170. Epub 2012 Jul 31.

DOI:10.5812/traumamon.4170

PMID:24350104

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3860642/

Abstract

BACKGROUND

Rapid Response Teams (RRTs) assess patients during early phases of deterioration to reduce patient morbidity and mortality.

OBJECTIVES

This study aimed to evaluate the ability of earlier medical intervention by a RRT prompted by clinical instability in patients to reduce the incidence of and mortality from unexpected cardiac arrest at our hospital.

PATIENTS AND METHODS

A nonrandomized, population-based study before 2008 and after 2010 introduction of the Rapid Response Teams in a 300 bed private hospital. All patients were admitted to the hospital in 2008 (n = 25348) and 2010 (n = 28024). RRT (One doctor, one senior intensive care nurse and one staff nurse) attended to clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response was activated by the bedside nurse or doctor according to predefined criteria. Main outcome measures were incidence and outcome of unexpected cardiac arrest.

RESULTS

The incidence of unexpected cardiac arrest was 17 per 1000 hospital admissions (431 cases) in 2008 (before RRT intervention) and 12.45 per 1000 admissions (349 cases) in 2010 (after intervention), with mortality being 73.23% (274 patients) and 66.15% (231 patients) respectively. After adjustment for case mix the intervention was associated with a 19% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.81, 95% confidence interval 0.65-0.98).

CONCLUSIONS

The RRT was able to detect preventable adverse events and reduce the mortality and incidence of unexpected cardiac arrests.

摘要

背景

快速反应小组（RRTs）在患者病情恶化的早期阶段对其进行评估，以降低患者的发病率和死亡率。

目的

本研究旨在评估由临床不稳定情况引发的快速反应小组进行早期医疗干预，能否降低我院意外心脏骤停的发生率和死亡率。

患者与方法

这是一项非随机的、基于人群的研究，研究对象为2008年之前以及2010年在一家拥有300张床位的私立医院引入快速反应小组之后收治的患者。所有患者分别于2008年（n = 25348）和2010年（n = 28024）入院。快速反应小组（一名医生、一名高级重症监护护士和一名普通护士）会立即携带复苏药物、液体和设备对临床不稳定的患者进行救治。床边护士或医生根据预定义标准启动反应。主要观察指标为意外心脏骤停的发生率和结局。

结果

2008年（快速反应小组干预前）意外心脏骤停的发生率为每1000例住院患者中有17例（431例），2010年（干预后）为每1000例住院患者中有12.45例（349例），死亡率分别为73.23%（274例患者）和66.15%（231例患者）。在对病例组合进行调整后，干预与意外心脏骤停发生率降低19%相关（比值比0.81，95%置信区间0.65 - 0.98）。