Pre-arrest signs in different types of hospitals

Aim

To compare the incidence of pre-arrest signs in patients suffering unexpected cardiac arrest in different types of hospitals.

Methods

We reviewed the records of the patients who suffered unexpected cardiac arrest during an 18-month period in a tertiary teaching hospital, in a tertiary trauma hospital and in two secondary hospitals. Data on patient characteristics and observations and interventions during the 8 hours preceding cardiac arrest were collected. The findings were evaluated against the calling criteria of the Medical Emergency Team (MET) [1].

Results

In the four hospitals, 110 patient records were reviewed. Fifty-six of the cardiac arrests occurred on a ward and 25 (45%) of these patients fulfilled MET calling criteria. The mean time from the first documented abnormal vital sign to the arrest was 3.8 hours (range 0.25–8.00 hours). The proportion of patients meeting MET criteria differed significantly between the tertiary teaching hospital, the two secondary hospitals and the trauma hospital (14%, 27%, 69% and 80%, respectively; chi-square P < 0.001). The most frequent criteria were respiratory distress, SpO₂ < 90% on oxygen and systolic blood pressure < 90 mmHg. Of the patients suffering cardiac arrest elsewhere than on a ward (i.e. coronary care unit), 22% fulfilled MET criteria, but these patients received immediately intensive treatment.

Conclusion

The incidence of pre-arrest signs and thus the potential benefit of a MET, which is called when certain criteria fulfils, appears to vary considerably between hospitals of different types.