A Trigger and Response System for Preventing Cardiac Arrest in the ICU.
A Trigger and Response System for Preventing Cardiac Arrest in the ICU.
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DOI：
10.1097/cce.0000000000000557
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发表时间：
2021-10
影响因子：
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通讯作者：
Donnino MW
中科院分区：
文献类型：
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作者：
Moskowitz A;Berg KM;Cocchi MN;Grossestreuer AV;Issa M;Balaji L;Chase M;Yang JX;Sarge J;O'Donoghue S;Sarge T;Donnino MW
文本中提供了补充数字内容。尽管 ICU 中的患者受到密切监测，但一些 ICU 心脏骤停事件是可以预防的。在这项研究中，我们试图通过质量改进举措来降低 ICU 中心脏骤停的发生率。前瞻性、观察性研究。单一三级护理中心的 ICU。 2017 年 8 月至 2019 年 11 月期间入住 ICU 的患者。综合触发和响应工具。 43 名患者在干预前经历了 ICU 心脏骤停（每 1,000 例出院中有 6.79 例心脏骤停），59 例患者在干预期间经历了 ICU 心脏骤停（每 1,000 例出院有 7.91 例心脏骤停）。在干预时期，临床触发和反应工具在 1 年时间内被激活 106 次，最常见的是由于意外的新发/恶化的低血压。与干预前和干预时间相比，逮捕率（2.24 名逮捕/1,000 名患者；95% CI，–1.82 至 6.28；p = 0.28）或斜率变化（逮捕率–0.02 斜率；95% CI，–0.14 至 0.11；p = 0.79）没有阶跃变化。干预前时期的心脏骤停比干预时期更有可能是“潜在可预防的”（分别为 25.6% 和 12.3%；比值比，0.58；95% CI，0.20-0.88；p < 0.01）。一种新型的触发和响应工具并没有降低 ICU 心脏骤停的频率。需要进一步研究 ICU 心脏骤停预防的最佳方法。
Supplemental Digital Content is available in the text. Although patients in the ICU are closely monitored, some ICU cardiac arrest events may be preventable. In this study, we sought to reduce the rate of cardiac arrests occurring in the ICU through a quality improvement initiative. Prospective, observational study. ICUs of a single tertiary care center. Patients hospitalized in the ICUs between August 2017 and November 2019. A comprehensive trigger and response tool. Forty-three patients experienced an ICU cardiac arrest in the preintervention epoch (6.79 arrests per 1,000 discharges), and 59 patients experienced an ICU cardiac arrest in the intervention epoch (7.91 arrests per 1,000 discharges). In the intervention epoch, the clinical trigger and response tool was activated 106 times over a 1-year period, most commonly due to unexpected new/worsening hypotension. There was no step change in arrest rate (2.24 arrests/1,000 patients; 95% CI, –1.82 to 6.28; p = 0.28) or slope change (–0.02 slope of arrest rate; 95% CI, –0.14 to 0.11; p = 0.79) comparing the preintervention and intervention time epochs. Cardiac arrests in the preintervention epoch were more likely to be “potentially preventable” than that in the intervention epoch (25.6% vs 12.3%, respectively; odds ratio, 0.58; 95% CI, 0.20–0.88; p < 0.01). A novel trigger-and-response tool did not reduce the frequency of ICU cardiac arrest. Additional investigation is needed into the optimal approach for ICU cardiac arrest prevention.