Clinical Antecedents to In-Hospital Cardiopulmonary Arrest After Institution of a Rapid Response Team

PURPOSE: The concept of the Rapid Response Team (RRT) originated from the observation that patients receiving care in hospitals often had physiological deterioration several hours prior to a cardiac or respiratory arrest. The purpose of this study was to analyze the 24 hour time period prior to an arrest to evaluate the utilization of the RRT and to determine if there were clinical antecedents indicating physiologic demise. SUBJECTS: Subjects were identified as having a cardiac or respiratory arrest within a one year time period. METHODS: A case control design was used in this study. A data collection tool was utilized to document demographic information, laboratory values, and cardiovascular, respiratory, central nervous system and renal parameters 24 hours prior to the arrest. ANALYSIS: Descriptive statistics were used to describe the use of the rapid response team. RESULTS: Twenty four hours prior to the arrest, the RRT was called in 10 cases for the following reasons: unresponsiveness and altered mental status. A consistent physiologic parameter was not identified as a predictor of demise. However, the following observations in the 24 hours prior to the arrest were made: mental status changes (17subjects), documented arrhythmias (20 subjects), change in speaking (10subjects), and chest pain (10 subjects). CONCLUSIONS: 10% of subjects who had a cardiopulmonary arrest had a prior RRT intervention and there was not a consistent physiologic indicator of arrest in the prior 24 hours which would have indicated physiologic demise