JAMA: In-hospital rapid response team does not reduce cardio arrests, deaths

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Although there is an effort to implement rapid response teams in hospitals throughout the country, they do not result in a reduced rate of cardiopulmonary arrests or deaths, according to a study in the Dec. 3 issue of the Journal of the American Medical Association.

Paul S. Chan, MD, of the Mid America Heart Institute and University of Missouri in Kansas City, and colleagues examined the association between a rapid response team intervention and long-term changes in hospital-wide cardiopulmonary arrest and mortality rates. The study included adult inpatients admitted between January 2004 and August 2007 at a 404-bed tertiary care academic hospital in Kansas City. Rapid response team education and program rollout occurred from Sept. 1 to Dec. 31, 2005.

The researchers evaluated 24,193 patient admissions prior to the intervention (Jan. 1, 2004 to Aug. 31, 2005), and 24,978 admissions after the intervention (Jan. 1, 2006 to Aug. 31, 2007).

During the 20-month period after intervention implementation, there were 376 rapid response team activations, according to the authors. The most common reasons for rapid response team activation were altered neurological status, tachycardia exceeding 130 beats per minute, tachypnea exceeding 30 breaths per minute, and hypotension assessed as blood pressure lower than 90 mm Hg.

Hospital-wide code rates per 1,000 admissions were 11.2 before rapid response team intervention and 7.5 after rapid response team intervention, the researchers said. This was not associated with a reduction in the primary outcome measure of hospital-wide code rates, with decreases in non-ICU code rates accounting for the majority of this difference.

Chan and colleagues found that case fatality rates after cardiopulmonary arrest were similar prior to and after the rapid response team intervention (77.9 vs. 76.1 percent).

They found that hospital-wide mortality rates did not meaningfully change after the rapid response team intervention (3.22 pre-intervention vs. 3.09 postintervention per 100 admissions). Secondary analyses revealed few instances of rapid response team undertreatment or underuse that may have affected the mortality findings.

“We believe that this study provides important new insights regarding the effectiveness and limitations of rapid response team intervention and raises critical questions about whether recommendations to disseminate rapid response teams nationally are warranted without a demonstrable mortality benefit,” the authors wrote.