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Can J Anaesth. 2018 Dec;65(12):1303-1313. doi: 10.1007/s12630-018-1200-5. Epub 2018 Aug 3.

A rapid response system reduces the incidence of in-hospital postoperative cardiopulmonary arrest: a retrospective study.

Author information

1
Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
2
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
3
Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
4
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
5
Division of Intensive Care Medicine, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.
6
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
7
Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. songoficu@outlook.kr.
8
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. songoficu@outlook.kr.

Abstract

PURPOSE:

Rapid response systems (RRSs) have been introduced into hospitals to help reduce the incidence of sudden cardiopulmonary arrest (CPA). This study evaluated whether an RRS reduces the incidence of in-hospital postoperative CPA.

METHODS:

This retrospective before-and-after analysis evaluated data collected from electronic medical records during a pre-intervention (January 2008 to September 2012) and post-intervention (implementation of an RRS) interval (October 2012 to December 2016) at a single tertiary care institution. The primary outcome was a change in the rate of CPA in surgical patients recovering in a general ward. A Poisson regression analysis adjusted for the Charlson Comorbidity Index (CCI) was used to compare CPA rates during these two intervals.

RESULTS:

Of the 207,054 surgical procedures performed during the study period, mean (95% confidence interval [CI]) CPA events per 10,000 cases of 7.46 (5.72 to 9.19) and 5.19 (3.85 to 6.52) were recorded before and after RRS intervention, respectively (relative risk [RR], 0.73; 97.5% CI, 0.48 to 1.13; P = 0.103). Cardiopulmonary arrest incidence was reduced during RRS operational hours of 07:00-22:00 Monday-Friday and 07:00-12:00 Saturday (RR, 0.56; 97.5% CI, 0.31 to 1.02; P = 0.027) but was unchanged when the RRS was not operational (RR, 0.86; 97.5% CI, 0.52 to 1.40; P = 0.534). The CCI-adjusted RR of CPA after RRS implementation was lower than before RRS intervention (0.63; 97.5% CI, 0.41 to 0.98; P = 0.018) but this reduction was still only apparent during RRS operational hours (RR, 0.48; 97.5% CI, 0.27 to 0.89; P = 0.008 vs RR, 0.85; 97.5% CI, 0.45 to 1.58; P = 0.55).

CONCLUSION:

Implementation of an RRS reduced the incidence of postoperative CPA in patients recovering in a general ward. Furthermore, this reduction was observed only during RRS operational hours.

PMID:
30076577
DOI:
10.1007/s12630-018-1200-5

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