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Paediatric cardiac rapid response systems: a survey of multicentre practices

Published online by Cambridge University Press:  19 August 2021

Aarti C. Bavare Open the ORCID record for Aarti C. Bavare [Opens in a new window] ,
Natasha S. Afonso ,
Kerry A. Sembera ,
Jason R. Buckley ,
Tia T. Raymond Open the ORCID record for Tia T. Raymond [Opens in a new window] ,
Angela McKeta Open the ORCID record for Angela McKeta [Opens in a new window]  and
John M. Costello
Aarti C. Bavare*
Affiliation:
Department of Paediatrics, Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
Natasha S. Afonso
Affiliation:
Department of Paediatrics, Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
Kerry A. Sembera
Affiliation:
Cardiac Critical Care, Texas Children’s Hospital, Houston, TX, USA
Jason R. Buckley
Affiliation:
Department of Paediatrics, Medical University of South Carolina College of Medicine, MUSC Children’s Hospital, Charleston, SC, USA
Tia T. Raymond
Affiliation:
Department of Paediatrics, Cardiac Critical Care, Medical City Children’s Hospital, Dallas, TX, USA
Angela McKeta
Affiliation:
Department of Paediatrics, Medical University of South Carolina College of Medicine, MUSC Children’s Hospital, Charleston, SC, USA
John M. Costello
Affiliation:
Department of Paediatrics, Medical University of South Carolina College of Medicine, MUSC Children’s Hospital, Charleston, SC, USA
*
Author for correspondence: A.C. Bavare, MD, MPH, Department of Paediatrics, Critical Care Medicine, Baylor College of Medicine, 6651 Main Street, MC: E1480.52, Houston, TX 77030, USA. Tel: 8328266257; Fax: 8328264252. E-mail: [email protected]
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Abstract

Introduction:

While the efficacy and guidelines for implementation of rapid response systems are well established, limited information exists about rapid response paradigms for paediatric cardiac patients despite their unique pathophysiology.

Methods:

With endorsement from the Paediatric Cardiac Intensive Care Society, we designed and implemented a web-based survey of paediatric cardiac and multidisciplinary ICU medical directors in the United States of America and Canada to better understand paediatric cardiac rapid response practices.

Results:

Sixty-five (52%) of 125 centres responded. Seventy-one per cent of centres had ∼300 non-ICU beds and 71% had dedicated cardiac ICUs. To respond to cardiac patients, dedicated cardiac rapid response teams were utilised in 29% of all centres (39% and 5% in centres with and without dedicated cardiac ICUs, respectively) [p = 0.006]. Early warning scores were utilised in 62% of centres. Only 31% reported that rapid response teams received specialised training. Transfers to ICU were higher for cardiac (73%) compared to generalised rapid response events (54%). The monitoring and reassessment of patients not transferred to ICU after the rapid response was variable. Cardiac and respiratory arrests outside the ICU were infrequent. Only 29% of centres formally appraise critical deterioration events (need for ventilation and/or inotropes post-rapid response) and 34% perform post-event debriefs.

Conclusion:

Paediatric cardiac rapid response practices are variable and dedicated paediatric cardiac rapid response systems are infrequent in the United States of America and Canada. Opportunity exists to delineate best practices for paediatric cardiac rapid response and standardise practices for activation, training, patient monitoring post-rapid response events, and outcomes evaluation.

Keywords

Rapid response teamspaediatriccardiac critical careclinical outcomescardiac arrest
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 6 , June 2022 , pp. 944 - 951
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Maharaj, R, Raffaele, I, Wendon, J. Rapid response systems: a systematic review and meta-analysis. Crit Care 2015; 19: 254. DOI: 10.1186/s13054-015-0973-y.CrossRefGoogle ScholarPubMed
Chan, PS, Khalid, A, Longmore, LS, et al. Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA 2008; 300: 2506–2513. DOI: 10.1001/jama.2008.715.CrossRefGoogle ScholarPubMed
Sharek, PJ, Parast, LM, Leong, K, et al. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children’s Hospital. JAMA 2007; 298: 2267–2274. DOI: 10.1001/jama.298.19.2267.CrossRefGoogle ScholarPubMed
Kotsakis, A, Lobos, AT, Parshuram, C, et al. Ontario Pediatric Critical Care Response Team Collaborative: implementation of a multicenter rapid response system in pediatric academic hospitals is effective. Pediatrics 2011; 128: 72–78. DOI: 10.1542/peds.2010-0756.CrossRefGoogle Scholar
Bonafide, CP, Localio, AR, Roberts, KE, et al. Impact of rapid response system implementation on critical deterioration events in children. JAMA 2014; 168: 25–33. DOI: 10.1001/jamapediatrics.2013.3266.Google ScholarPubMed
Kolovos, NS, Gill, J, Michelson, PH, Doctor, A, Hartman, ME. Reduction in mortality following pediatric rapid response team implementation. Pediatr Crit Care Med 2018; 19: 477–482. DOI: 10.1097/PCC.0000000000001519.CrossRefGoogle ScholarPubMed
Berwick, DM, Calkins, DR, McCannon, CJ, et al. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006; 295: 324–327. DOI: 10.1001/jama.295.3.324.CrossRefGoogle Scholar
The Joint Commission announces the 2009 National Patient Safety Goals and requirements. Jt Comm Perspect 2008; 28: 11–15.Google Scholar
Lee, A, Bishop, G, Hillman, KM, Daffurn, K. The medical emergency team. Anaesth Intensive Care 1995; 23: 183–186.CrossRefGoogle ScholarPubMed
Jones, DA, DeVita, MA, Bellomo, R. Rapid-response teams. N Eng J Med 2011; 365: 139–146.CrossRefGoogle ScholarPubMed
Devita, MA, Bellomo, R, Hillman, K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006; 34: 2463–2478.CrossRefGoogle ScholarPubMed
Peberdy, MA, Cretikos, M, Abella, BS, et al. Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an Utstein-style scientific statement. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Interdisciplinary Working Group. Resuscitation 2007; 75: 412–433.CrossRefGoogle Scholar
Marino, BS, Tabbutt, S, MacLaren, G, et al. American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Emergency Cardiovascular Care Committee. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association. Circulation 2018; 137: e691–e782.Google Scholar
Bavare, AC, Rafie, KS, Bastero, PX, Hagan, JL, Checchia, PA. Acute decompensation in pediatric cardiac patients: outcomes after rapid response events. Pediatr Crit Care Med 2017; 18: 414–419. DOI 10.1097/PCC.0000000000001117.CrossRefGoogle ScholarPubMed
Raymond, TT, Bonafide, CP, Praestgaard, A, et al. Pediatric Medical Emergency Team events and outcomes: a report of 3647 events from the American Heart Association’s Get With the Guidelines-Resuscitation Registry. Hosp Pediatr 2016; 6: 57–64. DOI: 10.1542/hpeds.2015-0132.CrossRefGoogle ScholarPubMed
Duncan, H, Hutchison, J, Parshuram, CS. The pediatric early warning system score: a severity of illness score to predict urgent medical need in hospitalized children. J Crit Care 2006; 21: 271–278. DOI: 10.1016/j.jcrc.2006.06.007.CrossRefGoogle ScholarPubMed
McLellan, MC, Connor, JA. The Cardiac Children’s Hospital Early Warning Score (C-CHEWS). J Pediatr Nurs 2013; 28: 171–178. DOI: 10.1016/j.pedn.2012.07.009.CrossRefGoogle Scholar
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