Improving CPR outcomes – querying the role of a “rapid response” team

Following cardiac arrest, delays in treatment are associated with poor neurological outcomes and lower survival rates.  A rapid response team – also known as a medical emergency team – is a multidisciplinary team designed to diagnose, evaluate and treat non intensive-care patients showing signs of clinical deterioration, the aim being to decrease the chances of a subsequent cardiac arrest.  Chan et al. investigated the rates of hospital-wide cardiac arrest codes and deaths before and after the introduction of a rapid response team at Saint Luke’s Hospital, Kansas City.

Overall there were 376 rapid response team activations, and the mean hospital-wide code rates decreased from 11.2 to 7.5 per 1000 admissions after the introduction of the rapid response team.  Lower rates of non-intensive-care codes were observed (non-ICU Adjusted Odds Ration [AOR], 0.59 [95% CI, 0.40-0.89] vs ICU AOR, 0.95 [95% CI, 0.64-1.43];P= .03 for interaction), but this did not translate into a reduction in hospital-wide mortality (3.22 vs 3.09 per 100 admissions;AOR, 0.95 [95% CI, 0.81-1.11];P= .52). Secondary analyses revealed no indication of underuse of the rapid response team that may have affected the mortality findings.

Many hospitals have now implemented a rapid response team as part of an initiative from the US Institute for Healthcare, but this study gives no indication that they actually save lives.  A number of confounding factors could apply, not the least the growing trend for “advanced directives” which could lessen the impact of the response team.  Furthermore, this study is relatively small in size, and is based at a single-center.  For more conclusive analysis, a larger trial will be required, with detailed analysis of patients’ comorbidities.

·      Chan S, Khalid A, Longmore LS et al.  Hospital-wide Code Rates and Mortality Before and After Implementation of a Rapid Response Team.  JAMA.  2008;300(21):2506-2513