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• Filed under: Features, Cover Story, Clinical

• Keywords: mortality, outcomes, QI, clinical trial, evaluation

In the Literature: Research You Need to Know

From: The eWire, 5.19.2010

Clinical question: Do rapid-response teams (RRTs) reduce the rates of cardiopulmonary arrest and hospital mortality?

Background: RRTs are charged with prompt evaluation and treatment of inpatients with clinical deterioration to prevent cardiopulmonary arrest and its attendant mortality. Though hundreds of hospitals have implemented these teams as part of their quality-improvement (QI) initiatives, previous studies on RRTs have reported mixed results on the clinically meaningful outcome of hospital mortality.

Study design: Meta-analysis and systematic review.

Setting: Randomized, controlled trials and prospective studies on RRTs from multiple databases, including PubMed, EMBASE, and CINAHL.

Synopsis: Eighteen studies (13 adult and five pediatric) with a total sample size of nearly 1.3 million admissions were analyzed. Of these, 15 reported on the primary outcome of in-hospital mortality; 16 reported on the secondary outcome of cardiopulmonary arrest. All of the studies exhibited extensive heterogeneity of outcomes, but six studies were deemed to be of high quality.

In adults, RRT implementation reduced non-ICU cardiopulmonary arrest by 33.8%, without an effect on hospital mortality (pooled RR, 0.96; 95% CI, 0.84-1.09). Interestingly, the inclusion of recent evidence neutralized positive results from initial studies in the overall pooled analysis.

In children, apart from reduction in arrest (37.7%), a weak association with lower mortality rates (pooled RR, 0.79; 95% CI, 0.63-0.98) was noticed. This did not hold on sensitivity analysis, but that could be explained by their higher likelihood to survive cardiac arrest than adults.

The discordance between the primary and secondary outcomes could be due to pre-arrest transfer to ICU or establishment of DNR status by RRT, hence excluding them from mortality analysis.

Bottom line: Although RRTs reduce rates of cardiopulmonary arrest outside the ICU, no consistent evidence shows RRTs improve survival to discharge.

Citation: Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams: a systematic review and meta-analysis. Arch Intern Med. 2010;170(1):18-26.

Reviewed for TH eWire by Rubin Bahuva, MD, Chadi Alraies, MD, Anuradha Ramaswamy, MD, Sudhir Manda, MD, Maria Giselle Velez, MD, and Mital Patel, MD, Department of Hospital Medicine, Cleveland Clinic

For more physician reviews of HM-related research, visit our website.