Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/32702
Title: Antecedents to and outcomes for in-hospital cardiac arrests in Australian hospitals with mature medical emergency teams: A multicentre prospective observational study.
Austin Authors: Jones, Daryl A ;Pound, Gemma;Serpa Neto, Ary ;Hodgson, Carol L;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Intensive Care
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC)
School of Public Health and Preventive Medicine, Monash University, Melbourne; Australia
University Melbourne University, Parkville, Melbourne
Physiotherapy Department, St. Vincent’s Hospital, Melbourne, Australia
Physiotherapy Department, The Alfred Hospital, Melbourne, Australia
Data Analytics Research and Evaluation (DARE) Centre
Department of Critical Care, University of Melbourne, Melbourne, Australia
The Alfred, Melbourne
The George Institute for Global Health
Centre for Integrated Critical Care, Melbourne University
Monash University
Critical Care Medicine, University of New South Wales
Howard Florey Institute of Physiology
ANZ Intensive Care Research Centre
Royal Melbourne Hospital
Warringal Private Hospital
Issue Date: Nov-2023
Date: 2023
Publication information: Australian Critical Care : official journal of the Confederation of Australian Critical Care Nurses 2023-11; 36(6)
Abstract: The epidemiology and predictability of in-hospital cardiac arrests (IHCAs) in hospitals with established medical emergency teams (METs) is underinvestigated. We categorised IHCAs into three categories: "possible suboptimal end-of-life planning" (possible SELP), "potentially predictable", or "sudden and unexpected" using age, Charlson Comorbidity Index, place of residence, functional independence, along with documented vital signs, K+ and HCO3 in the period prior to the IHCA. We also described the differences in characteristics and outcomes amongst these three categories of IHCAs. This was a prospective observational study (1st July 2017 to 9th August 2018) of adult (18 years) IHCA patients in wards of seven Australian hospitals with well-established METs. Amongst 152 IHCA patients, 145 had complete data. The number (%) classified as possible SELP, potentially predictable, and sudden and unexpected IHCA was 50 (34.5%), 52 (35.8%), and 43 (29.7%), respectively. Amongst the 52 potentially predictable patients, six (11.5%) had missing vital signs in the preceding 6 hr, 18 (34.6%) breached MET criteria in the prior 24 hr but received no MET call, and 6 (11.5%) had a MET call but remained on the ward. Abnormal K+ and HCO3 was present in 15 of 51 (29.5%) and 13 of 51 (25.5%) of such patients, respectively. The 43 sudden and unexpected IHCA patients were mostly (97.6%) functionally independent and had the lowest median Charlson Comorbidity Index. In-hospital mortality for IHCAs classified as possible SELP, potentially predictable, and sudden and unexpected was 76.0%, 61.5%, and 44.2%, respectively (p = 0.007). Only four of 12 (33.3%) possible SELP survivors had a good functional outcome. In seven Australian hospitals with mature METs, only one-third of IHCAs were sudden and unexpected. Improving end-of-life care in elderly comorbid patients and enhancing the response to objective signs of deterioration may further reduce IHCAs in the Australian context.
URI: https://ahro.austin.org.au/austinjspui/handle/1/32702
DOI: 10.1016/j.aucc.2023.01.011
ORCID: 0000-0002-6446-3595
0000-0003-1520-9387
0000-0002-1650-8939
Journal: Australian Critical Care : official journal of the Confederation of Australian Critical Care Nurses
PubMed URL: 37059632
Type: Journal Article
Subjects: Clinical deterioration
End-of-life care
In-hospital cardiac arrest
Medical emergency team
Rapid response system
Rapid response team
Appears in Collections:Journal articles

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