Ariyo Promise, Lee Seung W, Latif Asad, Egbuta Chinyere, Pandian Vinciya, Bankole Olufemi, Desalu Ibironke, Sampson John, Winters Bradford
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, United States.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.
Front Med (Lausanne). 2025 Jul 9;12:1583470. doi: 10.3389/fmed.2025.1583470. eCollection 2025.
Little is known about the incidence of clinical deterioration and cardiopulmonary arrest (CPA) on general hospital units in low-and middle-income countries (LMICs) or how rapid response systems (RRSs) might impact these events. Implementation of RRSs in high-income countries has been shown to reduce the incidence of CPA and mortality. The aim of this study was to determine whether implementation of an RRS is feasible in an LMIC medical center.
We developed and implemented an RRS in a large academic medical center in Lagos, Nigeria, in three phases: (1) Needs assessment and stakeholder engagement, (2) Infrastructure setup and education, and (3) Implementation and data collection. We collected data on incidence of rapid response events, attendance ratio and time of arrival of the designated clinical staff, triggers for the rapid response calls and common interventions at the events.
Over the 7 months study period, 997 patients were admitted to the intervention-eligible units, and 95 RRS events occurred in 55 patients. In 11 RRS activations (11.6%), no rapid response team member responded. Anesthesia residents attended 73.7% of the events, and anesthesia techs and nurses attended roughly 38% each. Internal medicine residents responded to 13.7% of RRS activations. The average time to arrival was 13 min. The most common trigger was altered mental status, followed by hypoxia and hypotension. Seventy-six percent of patients survived their initial RRS activation, and 83% died while in hospital. Common interventions were vasopressor use, oxygen supplementation, and intravenous fluid administration. No patient was transferred to the designated intensive care unit after an RRS activation owing to lack of beds. Six patients were transferred to the makeshift ICU, all of which required vasopressor support.
While barriers remain, the development and implementation of an RRS program in an LMIC medical center is feasible.
在低收入和中等收入国家（LMICs）的综合医院科室中，关于临床病情恶化和心肺骤停（CPA）的发生率，或者快速反应系统（RRSs）可能如何影响这些事件，人们了解甚少。在高收入国家实施RRSs已被证明可降低CPA的发生率和死亡率。本研究的目的是确定在一个LMIC医学中心实施RRS是否可行。
我们在尼日利亚拉各斯的一家大型学术医学中心分三个阶段开发并实施了一个RRS：（1）需求评估和利益相关者参与，（2）基础设施设置和教育，以及（3）实施和数据收集。我们收集了关于快速反应事件的发生率、指定临床工作人员的出勤比例和到达时间、快速反应呼叫的触发因素以及事件中的常见干预措施的数据。
在7个月的研究期间，997名患者被收治到符合干预条件的科室，55名患者发生了95次RRS事件。在11次RRS激活（11.6%）中，没有快速反应团队成员做出响应。麻醉住院医师参与了73.7%的事件，麻醉技术人员和护士分别参与了约38%的事件。内科住院医师对13.7%的RRS激活做出了响应。平均到达时间为13分钟。最常见的触发因素是精神状态改变，其次是缺氧和低血压。76%的患者在首次RRS激活后存活，83%的患者在住院期间死亡。常见的干预措施是使用血管加压药、补充氧气和静脉输液。由于床位不足，没有患者在RRS激活后被转至指定的重症监护病房。6名患者被转至临时重症监护病房，所有这些患者都需要血管加压药支持。
虽然障碍仍然存在，但在一个LMIC医学中心开发和实施RRS项目是可行的。
