Atkins Joshua H, Rassekh Christopher H, Chalian Ara A, Zhao Jing
Jt Comm J Qual Patient Saf. 2017 Dec;43(12):653-660. doi: 10.1016/j.jcjq.2017.07.002. Epub 2017 Aug 14.
Rapid response teams mobilize resources to patients experiencing acute deterioration. Failed airway management results in death or anoxic brain injury. A codified, systems-based approach to bring personnel and equipment to the bedside for multidisciplinary airway assessment and rescue was reflected in the initial implementation of an airway rapid response (ARR) team.
A retrospective review of records of 117 ARR events in a 40-month period (August 2011-November 2014) was undertaken at the Hospital of the University of Pennsylvania, a 789-bed, academic, urban, tertiary care, Level 1 trauma center.
Of the 117 ARR events, 60 (51.3%) were called in the ICU, and 43 (36.8%) in the general ward. A definitive airway was secured in all patients for whom airway management was attempted. A new surgical airway was performed in five of the patients. Seven patients went to the operating room for airway management. Nine patients died or had care withdrawn shortly after the ARR.
Difficult airway emergencies represent a small but critical element of airway rescue scenarios. Before the implementation of the ARR system, the process to bring the right team, equipment, expertise, and consensus on the right actions to critical airway emergencies was ad hoc. ARR activation, which brings multidisciplinary airway consultation, expert skills, and advanced airway equipment to the bedside, contributed to definitive airway management for surgical and nonsurgical airways. Performance of a bedside emergency surgical airway was uncommon. The ARR system represents a significant enhancement of the "anesthesia stat" system that typifies the airway emergency system at many institutions.
快速反应团队会为病情急性恶化的患者调动资源。气道管理失败会导致死亡或缺氧性脑损伤。气道快速反应（ARR）团队的最初实施体现了一种基于系统的规范化方法，即让人员和设备抵达床边进行多学科气道评估和抢救。
在宾夕法尼亚大学医院进行了一项回顾性研究，该医院是一家拥有789张床位的学术性城市三级护理一级创伤中心，研究时间段为40个月（2011年8月至2014年11月），回顾了117起ARR事件的记录。
在这117起ARR事件中，60起（51.3%）是在重症监护病房呼叫的，43起（36.8%）是在普通病房呼叫的。所有尝试进行气道管理的患者都成功建立了确定性气道。其中5名患者进行了新的外科气道手术。7名患者前往手术室进行气道管理。9名患者在ARR后不久死亡或放弃治疗。
困难气道紧急情况是气道抢救场景中一个虽小但关键的因素。在ARR系统实施之前，针对严重气道紧急情况召集合适的团队、设备、专业知识并就正确行动达成共识的过程是临时的。ARR的启动将多学科气道会诊、专业技能和先进气道设备带到床边，有助于对手术气道和非手术气道进行确定性气道管理。床边紧急外科气道手术并不常见。ARR系统代表了对许多机构典型的气道紧急系统“麻醉待命”系统的重大改进。
