A Trigger and Response System for Preventing Cardiac Arrest in the ICU.

Autor:	Moskowitz A; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.; Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY., Berg KM; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA., Cocchi MN; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Division of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA., Grossestreuer AV; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA., Issa M; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA., Balaji L; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA., Chase M; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA., Yang JX; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA., Sarge J; Beth Israel Deaconess Medical Center, Critical Care Nursing, Boston, MA., O'Donoghue S; Beth Israel Deaconess Medical Center, Critical Care Nursing, Boston, MA., Sarge T; Division of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA., Donnino MW; Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA.; Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2021 Oct 18; Vol. 3 (10), pp. e0557. Date of Electronic Publication: 2021 Oct 18 (Print Publication: 2021).
DOI:	10.1097/CCE.0000000000000557
Abstrakt:	Although patients in the ICU are closely monitored, some ICU cardiac arrest events may be preventable. In this study, we sought to reduce the rate of cardiac arrests occurring in the ICU through a quality improvement initiative. Design: Prospective, observational study. Setting: ICUs of a single tertiary care center. Patients: Patients hospitalized in the ICUs between August 2017 and November 2019. Interventions: A comprehensive trigger and response tool. Measurement and Main Results: Forty-three patients experienced an ICU cardiac arrest in the preintervention epoch (6.79 arrests per 1,000 discharges), and 59 patients experienced an ICU cardiac arrest in the intervention epoch (7.91 arrests per 1,000 discharges). In the intervention epoch, the clinical trigger and response tool was activated 106 times over a 1-year period, most commonly due to unexpected new/worsening hypotension. There was no step change in arrest rate (2.24 arrests/1,000 patients; 95% CI, -1.82 to 6.28; p = 0.28) or slope change (-0.02 slope of arrest rate; 95% CI, -0.14 to 0.11; p = 0.79) comparing the preintervention and intervention time epochs. Cardiac arrests in the preintervention epoch were more likely to be "potentially preventable" than that in the intervention epoch (25.6% vs 12.3%, respectively; odds ratio, 0.58; 95% CI, 0.20-0.88; p < 0.01). Conclusions: A novel trigger-and-response tool did not reduce the frequency of ICU cardiac arrest. Additional investigation is needed into the optimal approach for ICU cardiac arrest prevention. Competing Interests: Drs. Moskowitz and Berg are additionally funded through National Institutes of Health grants K23GM128005 and K23 HL128814, respectively. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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