Natalie Jayaram1, Maya L Chan2, Fengming Tang3, Christopher S Parshuram4, Paul S Chan3. 1. Children's Mercy Hospitals and Clinics, Kansas City, MO, United States. Electronic address: njayaram@cmh.edu. 2. Pembroke Hill High School, Kansas City, MO, United States. 3. Saint Luke's Mid America Heart Institute, Kansas City, MO, United States. 4. The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: Medical Emergency Teams (METs) are designed to respond to signs of clinical decline in order to prevent cardiopulmonary arrest and reduce mortality. The frequency of MET activation prior to pediatric cardiopulmonary resuscitation (CPR) is unknown. METHODS: Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children with bradycardia or cardiac arrest requiring CPR on the general inpatient or telemetry floors from 2007 to 2013. We examined the frequency with which CPR outside the ICU was preceded by a MET evaluation. In cases where MET evaluation did not occur, we examined the frequency of severely abnormal vital signs at least 1hour prior to CPR that could have prompted a MET evaluation but did not. RESULTS: Of 215 children from 23 hospitals requiring CPR, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to CPR were older (6.8±6.5 vs. 3.1±4.7 years of age, p<0.001) and were more likely to have metabolic/electrolyte abnormalities (18.8% vs. 5.4%, p=0.006), sepsis (16.7% vs. 4.8%, p=0.01), or malignancy (22.9% vs. 5.4%, p<0.001). Among patients who did not have a MET called and with information on vital signs, 55/141 (39.0%) had at least one abnormal vital sign that could have triggered a MET. CONCLUSION: The majority of pediatric patients requiring CPR for bradycardia or cardiac arrest do not have a preceding MET evaluation despite a significant number meeting criteria that could have triggered the MET. This suggests opportunities to more efficiently use MET teams in routine care.
BACKGROUND: Medical Emergency Teams (METs) are designed to respond to signs of clinical decline in order to prevent cardiopulmonary arrest and reduce mortality. The frequency of MET activation prior to pediatric cardiopulmonary resuscitation (CPR) is unknown. METHODS: Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children with bradycardia or cardiac arrest requiring CPR on the general inpatient or telemetry floors from 2007 to 2013. We examined the frequency with which CPR outside the ICU was preceded by a MET evaluation. In cases where MET evaluation did not occur, we examined the frequency of severely abnormal vital signs at least 1hour prior to CPR that could have prompted a MET evaluation but did not. RESULTS: Of 215 children from 23 hospitals requiring CPR, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to CPR were older (6.8±6.5 vs. 3.1±4.7 years of age, p<0.001) and were more likely to have metabolic/electrolyte abnormalities (18.8% vs. 5.4%, p=0.006), sepsis (16.7% vs. 4.8%, p=0.01), or malignancy (22.9% vs. 5.4%, p<0.001). Among patients who did not have a MET called and with information on vital signs, 55/141 (39.0%) had at least one abnormal vital sign that could have triggered a MET. CONCLUSION: The majority of pediatric patients requiring CPR for bradycardia or cardiac arrest do not have a preceding MET evaluation despite a significant number meeting criteria that could have triggered the MET. This suggests opportunities to more efficiently use MET teams in routine care.
Authors: R O Cummins; D Chamberlain; M F Hazinski; V Nadkarni; W Kloeck; E Kramer; L Becker; C Robertson; R Koster; A Zaritsky; L Bossaert; J P Ornato; V Callanan; M Allen; P Steen; B Connolly; A Sanders; A Idris; S Cobbe Journal: Circulation Date: 1997-04-15 Impact factor: 29.690
Authors: Ian Jacobs; Vinay Nadkarni; Jan Bahr; Robert A Berg; John E Billi; Leo Bossaert; Pascal Cassan; Ashraf Coovadia; Kate D'Este; Judith Finn; Henry Halperin; Anthony Handley; Johan Herlitz; Robert Hickey; Ahamed Idris; Walter Kloeck; Gregory Luke Larkin; Mary Elizabeth Mancini; Pip Mason; Gregory Mears; Koenraad Monsieurs; William Montgomery; Peter Morley; Graham Nichol; Jerry Nolan; Kazuo Okada; Jeffrey Perlman; Michael Shuster; Petter Andreas Steen; Fritz Sterz; James Tibballs; Sergio Timerman; Tanya Truitt; David Zideman Journal: Circulation Date: 2004-11-23 Impact factor: 29.690
Authors: Christopher P Bonafide; A Russell Localio; Kathryn E Roberts; Vinay M Nadkarni; Christine M Weirich; Ron Keren Journal: JAMA Pediatr Date: 2014-01 Impact factor: 16.193
Authors: Mary Ann Peberdy; William Kaye; Joseph P Ornato; Gregory L Larkin; Vinay Nadkarni; Mary Elizabeth Mancini; Robert A Berg; Graham Nichol; Tanya Lane-Trultt Journal: Resuscitation Date: 2003-09 Impact factor: 5.262
Authors: Tia T Raymond; Christopher P Bonafide; Amy Praestgaard; Vinay M Nadkarni; Robert A Berg; Christopher S Parshuram; Elizabeth A Hunt Journal: Hosp Pediatr Date: 2016-02
Authors: Richard J Brilli; Rosemary Gibson; Joseph W Luria; T Arthur Wheeler; Julie Shaw; Matt Linam; John Kheir; Patricia McLain; Tammy Lingsch; Amy Hall-Haering; Mary McBride Journal: Pediatr Crit Care Med Date: 2007-05 Impact factor: 3.624
Authors: Elizabeth A Hunt; Karen P Zimmer; Michael L Rinke; Nicole A Shilkofski; Carol Matlin; Catherine Garger; Conan Dickson; Marlene R Miller Journal: Arch Pediatr Adolesc Med Date: 2008-02
Authors: Hannah R Stinson; Shirley Viteri; Paige Koetter; Erica Stevens; Kristin Remillard; Rebecca Parlow; Jennifer Setlik; Meg Frizzola Journal: Pediatr Qual Saf Date: 2019-07-22