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The Medical Emergency Team in a university-affiliated hospital: The past, the present and the future
Abstracts / Resuscitation 85S (2014) S15–S121
AP205
Prognostication
The Medical Emergency Team in a university-affiliated hospital: The past, the present and the future
AP206
Raquel Silva ∗ , Manuel Saraiva, Maria José Lage, Gloria Campello, Irene Aragao UCIP – Hospital Santo Antonio, Porto, Portugal Purpose of the study: To describe the evolution from our cardiac arrest team (CAT) to Medical Emergency Team (MET) and analyze all calls and its outcomes. Materials and methods: Retrospective cohort study from January 1995 to July 2013. Results: In 1994 the first national cardiac arrest team was organized in this hospital, although calls only started to be registered in 1995. This organization remained like this until 2010 when a MET system was implemented. Activation of the MET team was made by pre-determined and publicized criteria. Part of the implementation included mass training in BLS and early recognition of the activation criteria. Between 1995 and 2010, the CAT was activated 1820 times. Activation for non-cardiac arrest situations steadily increased, reaching 60% of all calls in the last 3 years which prompt the readjustment of the CAT to MET (Fig. 1) Since 2011 the MET was activated 630 times, only 25% were for CA, 464 activations were due to other criteria. The median time that the team stayed with the patient was 35 (20–50) min. After MET intervention: 30% stayed in the same place (ward), 9.2% were admitted into ICU, 7.8% were transferred to high dependency units. At hospital discharge 15% of patients who were attended due to CA scenarios and 44% of those that needed MET intervention due to other criteria were alive.
S103
PCT levels as predictors of neurological outcome in patients with cardiac arrest treated with therapeutic hypothermia: A retrospective study Joseph Varon 1,∗ , Santiago Herrero 2 , Samuel Ricardo Torres-Landa 1 , Ishay Leff-Podoswa 1 , Samantha Fernandez 1 , Ileana DeAnda 1 , Alan Padilla-Ramos 1 , Kees Polderman 3 1
University General Hospital, Houston, USA Hospital de Cabue˜ nes, Gijón, Spain 3 University of Pittsburgh, Pittsburgh, USA 2
Background/objective: Procalcitonin (PCT) is a biomarker that is widely used to identify bacterial infections, confirm a diagnosis of sepsis, to monitor response to antibacterial therapy, and to assess general inflammatory response. Our goal was to assess the use of PCT levels as predictors of neurological outcome in patients who suffered cardiac arrest (CA) and underwent mild therapeutic hypothermia at 32 ◦ C for a period of 24 h (TH). Methods: 51 patients with CA who underwent TH were enrolled. 3 PCT measurements were obtained: (PCT-1 prior to TH, PCT-2 during TH and PCT-3 after TH). Neurological outcome was evaluated with the Cerebral Performance Category (CPC). The mean PCT was obtained in each measurement (PCT1, PCT2 and PCT3) and was correlated to f neurological assessment after TH treatment was completed. Results: 31.7% of our patients had CPC 1, 7.84% had CPC 2, and 58.82% had CPC > 3 and average PCT levels in patients with CPC 1 were: PCT 1 = 1.69; PCT 2 = 2.46; PCT 3 = 1.48. PCT levels in patients with CPC 2 were: PCT 1 = 0.59; PCT 2 = 0.21; PCT 3 = 1.57. PCT levels in patients with CPC > 3 were: PCT 1 = 3.81; PCT 2 = 5.4 and PCT 3 = 4.1. PCT 1 PCT 2 PCT 3
CPC 1
CPC 2
CPC 3
1.69 2.46 1.48
0.59 0.21 1.57
3.81 5.4 4.1
Conclusion: Our study shows a significant correlation between PCT levels and neurological outcome in CA patients treated with TH. Lower PCT levels were correlated with CPC 1–2, while higher PCT predicted CPC > 3. PCT levels could potentially be used to predict neurological outcome in CA patients treated with TH after CA. http://dx.doi.org/10.1016/j.resuscitation.2014.03.255 Fig. 1. Number of calls between 2003 and 2012.
Conclusions: The evolution from cardiac arrest team to MET system was profitable as showed by a decrease in the number of activations for cardiac arrest. From those that survived, most of them remained in the ward. Following new technologies the implementation of an online register system will allow periodic audits and monitoring in order to continuously improve of the process.
AP207 Factors influencing the decision to complete a do not attempt cardiopulmonary resuscitation order Nicholas Moore 1,∗ , Natasha Wiggins 2 , Joe Adams 2 1 2
http://dx.doi.org/10.1016/j.resuscitation.2014.03.254
Royal London Hospital, London, UK Colchester General Hospital, Colchester, UK
Introduction: “Do not attempt cardiopulmonary resuscitation” (DNACPR) orders are completed based on multiple patient characteristics in anticipation of deterioration. The 2010 European Resuscitation Council (ERC) guidelines stipulate that “resuscitation should not be attempted in obviously futile cases.” The effect of age on outcome following attempted cardiopulmonary resuscitation is controversial. We were interested in the role that advancing
AP205
Prognostication
The Medical Emergency Team in a university-affiliated hospital: The past, the present and the future
AP206
Raquel Silva ∗ , Manuel Saraiva, Maria José Lage, Gloria Campello, Irene Aragao UCIP – Hospital Santo Antonio, Porto, Portugal Purpose of the study: To describe the evolution from our cardiac arrest team (CAT) to Medical Emergency Team (MET) and analyze all calls and its outcomes. Materials and methods: Retrospective cohort study from January 1995 to July 2013. Results: In 1994 the first national cardiac arrest team was organized in this hospital, although calls only started to be registered in 1995. This organization remained like this until 2010 when a MET system was implemented. Activation of the MET team was made by pre-determined and publicized criteria. Part of the implementation included mass training in BLS and early recognition of the activation criteria. Between 1995 and 2010, the CAT was activated 1820 times. Activation for non-cardiac arrest situations steadily increased, reaching 60% of all calls in the last 3 years which prompt the readjustment of the CAT to MET (Fig. 1) Since 2011 the MET was activated 630 times, only 25% were for CA, 464 activations were due to other criteria. The median time that the team stayed with the patient was 35 (20–50) min. After MET intervention: 30% stayed in the same place (ward), 9.2% were admitted into ICU, 7.8% were transferred to high dependency units. At hospital discharge 15% of patients who were attended due to CA scenarios and 44% of those that needed MET intervention due to other criteria were alive.
S103
PCT levels as predictors of neurological outcome in patients with cardiac arrest treated with therapeutic hypothermia: A retrospective study Joseph Varon 1,∗ , Santiago Herrero 2 , Samuel Ricardo Torres-Landa 1 , Ishay Leff-Podoswa 1 , Samantha Fernandez 1 , Ileana DeAnda 1 , Alan Padilla-Ramos 1 , Kees Polderman 3 1
University General Hospital, Houston, USA Hospital de Cabue˜ nes, Gijón, Spain 3 University of Pittsburgh, Pittsburgh, USA 2
Background/objective: Procalcitonin (PCT) is a biomarker that is widely used to identify bacterial infections, confirm a diagnosis of sepsis, to monitor response to antibacterial therapy, and to assess general inflammatory response. Our goal was to assess the use of PCT levels as predictors of neurological outcome in patients who suffered cardiac arrest (CA) and underwent mild therapeutic hypothermia at 32 ◦ C for a period of 24 h (TH). Methods: 51 patients with CA who underwent TH were enrolled. 3 PCT measurements were obtained: (PCT-1 prior to TH, PCT-2 during TH and PCT-3 after TH). Neurological outcome was evaluated with the Cerebral Performance Category (CPC). The mean PCT was obtained in each measurement (PCT1, PCT2 and PCT3) and was correlated to f neurological assessment after TH treatment was completed. Results: 31.7% of our patients had CPC 1, 7.84% had CPC 2, and 58.82% had CPC > 3 and average PCT levels in patients with CPC 1 were: PCT 1 = 1.69; PCT 2 = 2.46; PCT 3 = 1.48. PCT levels in patients with CPC 2 were: PCT 1 = 0.59; PCT 2 = 0.21; PCT 3 = 1.57. PCT levels in patients with CPC > 3 were: PCT 1 = 3.81; PCT 2 = 5.4 and PCT 3 = 4.1. PCT 1 PCT 2 PCT 3
CPC 1
CPC 2
CPC 3
1.69 2.46 1.48
0.59 0.21 1.57
3.81 5.4 4.1
Conclusion: Our study shows a significant correlation between PCT levels and neurological outcome in CA patients treated with TH. Lower PCT levels were correlated with CPC 1–2, while higher PCT predicted CPC > 3. PCT levels could potentially be used to predict neurological outcome in CA patients treated with TH after CA. http://dx.doi.org/10.1016/j.resuscitation.2014.03.255 Fig. 1. Number of calls between 2003 and 2012.
Conclusions: The evolution from cardiac arrest team to MET system was profitable as showed by a decrease in the number of activations for cardiac arrest. From those that survived, most of them remained in the ward. Following new technologies the implementation of an online register system will allow periodic audits and monitoring in order to continuously improve of the process.
AP207 Factors influencing the decision to complete a do not attempt cardiopulmonary resuscitation order Nicholas Moore 1,∗ , Natasha Wiggins 2 , Joe Adams 2 1 2
http://dx.doi.org/10.1016/j.resuscitation.2014.03.254
Royal London Hospital, London, UK Colchester General Hospital, Colchester, UK
Introduction: “Do not attempt cardiopulmonary resuscitation” (DNACPR) orders are completed based on multiple patient characteristics in anticipation of deterioration. The 2010 European Resuscitation Council (ERC) guidelines stipulate that “resuscitation should not be attempted in obviously futile cases.” The effect of age on outcome following attempted cardiopulmonary resuscitation is controversial. We were interested in the role that advancing