GENERAL CARDIOLOGY

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

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 seen (non-ICU adjusted odds ratio (aOR) = 0.59 (95% CI 0.40 to 0.89) vs ICU aOR = 0.95 (95% CI 0.64 to 1.43); p = 0.03 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 to 1.11); p = 0.52). Secondary analyses showed no indication of underuse of the rapid response team that might 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 least the growing trend for “advanced directives”, which could lessen the impact of the response team. Furthermore, this study was relatively small in size, and based at a single centre. For more conclusive analysis, a larger trial will be required, with detailed analysis of patients’ comorbidities.

▸ Chan S, Khalid A, Longmore LS, . Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA 2008;300:2506–13.

Ambulatory blood pressure monitoring useful in resistant hypertension

Among patients with resistant hypertension (RH)—defined as the failure to control blood pressure (BP) despite optimal treatment with at least three antihypertensive drugs …