Thorén Anna, Jonsson Martin, Spångfors Martin, Joelsson-Alm Eva, Jakobsson Jan, Rawshani Araz, Kahan Thomas, Engdahl Johan, Jadenius Arvid, Boberg von Platen Erik, Herlitz Johan, Djärv Therese
Department of Medicine Solna, Center for Resuscitation Science, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Physiology, Danderyd University Hospital, SE-182 88 Stockholm, Sweden.
Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, SE-118 83 Stockholm, Sweden.
Resuscitation. 2023 Dec;193:109978. doi: 10.1016/j.resuscitation.2023.109978. Epub 2023 Sep 22.
Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.
A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.
In all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90-0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001).
IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.
快速反应小组（RRTs）旨在改善院内心脏骤停（IHCA）的“预防链”。我们研究了在IHCA发生前24小时内由RRTs评估的患者与未由RRTs评估的患者的30天生存率。
基于瑞典心肺复苏登记处进行的一项全国性队列研究，时间跨度为2014年1月1日至2021年12月31日。对由RRTs评估的普通病房患者的一个小亚组进行了探索性、产生假设的额外深入病历数据收集。
总共纳入了12915例IHCA患者。经RRTs评估的患者（n = 2058）未经调整的30天生存率较低（25%对33%，p < 0.001），基于倾向评分的30天生存优势比为0.92（95%置信区间0.90 - 0.94，p < 0.001），且更有可能因呼吸原因导致IHCA（22%对15%，p < 0.001）。在亚组（n = 82）中，呼吸窘迫是RRTs最常见的触发因素，24%的RRTs评估被延迟。患者转至更高水平的护理与更高的30天生存率相关（20%对2%，p < 0.001）。
在IHCA之前接受RRTs评估与较低的30天生存率以及心脏骤停由呼吸原因导致的可能性更大相关。在这个小探索性子组中，呼吸窘迫是RRTs最常见的触发因素，且RRTs激活延迟很常见。早期发现呼吸异常并及时干预可能有改善经RRTs评估患者结局并预防进一步发展为IHCA的潜力。
