Department of Intensive Care Medicine and Critical Care Medicine Research Group, Tampere University Hospital, Tampere, Finland; Medical School, University of Tampere, Tampere, Finland.
Acta Anaesthesiol Scand. 2014 Apr;58(4):420-7. doi: 10.1111/aas.12280. Epub 2014 Feb 19.
The implementation, characteristics and utilisation of cardiac arrest teams (CATs) and medical emergency teams (METs) in Finland are unknown. We aimed to evaluate how guidelines on advanced in-hospital resuscitation have been translated to practice.
A cross-sectional postal survey including all public hospitals providing anaesthetic services.
Of the 55 hospitals, 51 (93%) participated in the study. All hospitals with intensive care units (university and central hospitals, n = 24) took part. In total, 88% of these hospitals (21/24) and 30% (8/27) of the small hospitals had CATs. Most hospitals with CATs (24/29) recorded team activations. A structured debriefing after a resuscitation attempt was organised in only one hospital. The median incidence of in-hospital cardiac arrest in Finland was 1.48 (Q1 = 0.93, Q3 = 1.93) per 1000 hospital admissions. METs had been implemented in 31% (16/51) of the hospitals. A physician participated in MET activation automatically in half (8/16) of the teams. Operating theatres (13/16), emergency departments (10/16) and paediatric wards (7/16) were the most common sites excluded from the METs' operational areas. The activation thresholds for vital signs varied between hospitals. The lower upper activation threshold for respiratory rate was associated with a higher MET activation rate. The national median MET activation rate was 2.3 (1.5, 4.8) per 1000 hospital admissions and 1.5 (0.96, 4.0) per every cardiac arrest.
Current guidelines emphasise the preventative actions on in-hospital cardiac arrest. Practices are changing accordingly but are still suboptimal especially in central and district hospitals. Unified guidelines on rapid response systems are required.
芬兰的心脏骤停团队(CAT)和医疗应急团队(MET)的实施、特点和利用情况尚不清楚。我们旨在评估高级院内复苏指南在实践中的转化情况。
一项包括所有提供麻醉服务的公立医院的横断面邮寄调查。
在 55 家医院中,有 51 家(93%)参与了这项研究。所有拥有重症监护病房的医院(大学和中心医院,n=24)都参与了。其中,24 家(24/24)拥有 ICU 的医院和 30%(8/27)的小医院设有 CAT。大多数设有 CAT 的医院(29/29)都记录了团队的激活情况。只有一家医院在复苏尝试后进行了结构化的汇报。芬兰院内心脏骤停的中位数发生率为每 1000 次住院 1.48 次(Q1=0.93,Q3=1.93)。31%(16/51)的医院实施了 MET。在一半(8/16)的团队中,医生自动参与了 MET 的激活。手术室(16/16)、急诊科(10/16)和儿科病房(7/16)是最常见的被排除在 MET 行动区域之外的科室。医院之间的生命体征激活阈值各不相同。呼吸频率的较低上激活阈值与更高的 MET 激活率相关。全国范围内的 MET 激活率中位数为每 1000 次住院 2.3 次(1.5,4.8)和每例心脏骤停 1.5 次(0.96,4.0)。
当前的指南强调了院内心脏骤停的预防措施。实践正在相应改变,但在中心和地区医院仍然不理想。需要统一的快速反应系统指南。