Miryea Cisneros, Bachelors
Third-year medical student
Medical College of Wisconsin, United States
Disclosure information not submitted.
Paul Bergl, MD
Intensivist
Gundersen Lutheran Medical Center, United States
Disclosure information not submitted.
Title: ICU after RRT? A retrospective analysis of rapid response team interventions and 90-day mortality
Introduction: Rapid response teams (RRTs) provide expertise in situations of sudden, unanticipated patient decline and frequently facilitate the early delivery of critical care for high acuity patients. Although RRTs have been widely adopted into practice, some have questioned whether RRTs simply “shift” care i.e. avert cardiac arrest on wards only to have these patients die elsewhere. We hypothesized that inpatients transferred to the ICU (compared to those who remained on the ward) after RRT activation would have received fewer on-ward interventions (i.e. “shifted” care to ICU). We then explored whether a shift in deaths might be reflected in-hospital mortality and intermediate-term mortality.
Methods: We conducted a retrospective cohort study of inpatient RRT events. Clinical records were reviewed in the EHR. Our primary outcome was receipt of RRT interventions with an exploratory outcome of in-hospital and 90-day mortality. Potential explanatory variables for these outcomes included demographic data, severity of illness scores, and disposition after RRT.
Results: We analyzed 305 inpatients of whom 156 (51%) transferred to the ICU within 12 hours of RRT activation. Patients who went to the ICU were significantly more likely to have received medications (66% vs 54%, p< 0.05, chi-square), respiratory support (62% vs 41%, p< 0.0001), and additional monitoring (98.8% vs 83.7%, p< 0.0001) during RRT events than those who remained on ward. Patients transferred to the ICU also had lower survival to discharge (76% vs 92%, chi-square test, p< 0.001); however, 90-day mortality was only marginally worse among these patients (62.3% vs 51.2%, chi-square test, p< 0.05), a difference appears to be related to higher severity of illness among this cohort.
Conclusions: Inpatients who have an RRT activation have high 90-day mortality with risk for death, irrespective of whether they receive ICU care after RRT events during index hospitalization. ICU admission after RRT does not appear to be associated with a clinically significant reduction in 90-day mortality after accounting for severity of illness which we intend to confirm with multivariate logistic regression analysis. More research is needed to determine if certain patient characteristics can be used to identify RRT patients who may not benefit from ICU admission.