Long term effect of a medical emergency team on cardiac arrests in a teaching hospitalReport as inadecuate




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Critical Care

, 9:R808

First Online: 16 November 2005Received: 15 August 2005Accepted: 19 October 2005

Abstract

IntroductionIt is unknown whether the reported short-term reduction in cardiac arrests associated with the introduction of the medical emergency team MET system can be sustained.

MethodWe conducted a prospective, controlled before-and-after examination of the effect of a MET system on the long-term incidence of cardiac arrests. We included consecutive patients admitted during three study periods: before the introduction of the MET; during the education phase preceding the implementation of the MET; and a period of four years from the implementation of the MET system. Cardiac arrests were identified from a log book of cardiac arrest calls and cross-referenced with case report forms and the intensive care unit admissions database. We measured the number of hospital admissions and MET reviews during each period, performed multivariate logistic regression analysis to identify predictors of mortality following cardiac arrest and studied the correlation between the rate of MET calls with the rate of cardiac arrests.

ResultsBefore the introduction of the MET system there were 66 cardiac arrests and 16,246 admissions 4.06 cardiac arrests per 1,000 admissions. During the education period, the incidence of cardiac arrests decreased to 2.45 per 1,000 admissions odds ratio OR for cardiac arrest 0.60; 95% confidence interval CI 0.43–0.86; p = 0.004. After the implementation of the MET system, the incidence of cardiac arrests further decreased to 1.90 per 1,000 admissions OR for cardiac arrest 0.47; 95% CI 0.35–0.62; p < 0.0001. There was an inverse correlation between the number of MET calls in each calendar year and the number of cardiac arrests for the same year r = 0.84; p = 0.01, with 17 MET calls being associated with one less cardiac arrest. Male gender OR 2.88; 95% CI 1.34–6.19 and an initial rhythm of either asystole OR 7.58; 95% CI 3.15–18.25; p < 0.0001 or pulseless electrical activity OR 4.09; 95% CI 1.59–10.51; p = 0.003 predicted an increased risk of death.

ConclusionIntroduction of a MET system into a teaching hospital was associated with a sustained and progressive reduction in cardiac arrests over a four year period. Our findings show sustainability and suggest that, for every 17 MET calls, one cardiac arrest might be prevented.

AbbreviationsCIconfidence interval

ICUintensive care unit

METmedical emergency team

ORodds ratio.

Electronic supplementary materialThe online version of this article doi:10.1186-cc3906 contains supplementary material, which is available to authorized users.

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Author: Daryl Jones - Rinaldo Bellomo - Samantha Bates - Stephen Warrillow - Donna Goldsmith - Graeme Hart - Helen Opdam - Geoffrey

Source: https://link.springer.com/



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