Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 25;17(2):e0264272.
doi: 10.1371/journal.pone.0264272. eCollection 2022.

Incidence of preventable cardiopulmonary arrest in a mature part-time rapid response system: A prospective cohort study

Myung Jin Song  1 , Dong-Seon Lee  2 , Yun-Young Choi  2 , Da-Yun Lee  2 , Hye-Min Jo  2 , Sung Yoon Lim  1 , Jong Sun Park  1 , Young-Jae Cho  1 , Ho Il Yoon  1 , Jae Ho Lee  1 , Choon-Taek Lee  1 , Yeon Joo Lee  1
Affiliations

Incidence of preventable cardiopulmonary arrest in a mature part-time rapid response system: A prospective cohort study

Myung Jin Song et al. PLoS One. .

Abstract

Background: The purpose of a rapid response system (RRS) is to reduce the incidence of preventable cardiopulmonary arrests (CPAs) and patient deterioration in general wards. The objective of this study is to investigate the incidence and temporal trends of preventable CPAs and determine factors associated with preventable CPAs in a hospital with a mature RRS.

Methods: This was a single-center prospective cohort study of all CPAs occurring in the general ward between March 2017 and June 2020. The RRS operates from 07:00 to 23:00 on weekdays and from 07:00 to 12:00 on Saturdays. All CPAs were reviewed upon biweekly conference, and a panel of intensivists judged their preventability. Trends of preventable CPAs were analyzed using Poisson regression models and factors associated with preventable CPAs were analyzed using multivariable logistic regression.

Results: There were 253 CPAs over 40 months, and 64 (25.3%) of these were preventable. The incidence rate of CPAs was 1.07 per 1000 admissions and that of preventable CPAs was 0.27 per 1000 admissions. The number of preventable CPAs decreased by 24% each year (incidence rate ratio = 0.76; p = 0.039) without a change in the total CPA incidence. The most common contributor to the preventability was delayed response from physicians (n = 41, 64.1%). A predictable CPA with a pre-alarm sign had increased odds in the occurrence of preventable CPAs, while a cardiac cause of CPAs and RRS operating hours had decreased odds in terms of occurrence of preventable CPA.

Conclusion: Our study showed that one-fourth of all CPAs occurring in the general wards were preventable, and these arrests decreased each year. A mature RRS can evolve to reduce preventable CPAs with regular self-evaluation. Efforts should be directed at improving physicians' response time since a delay in their response was the most common cause of preventable CPAs.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Annual cardiopulmonary arrest (CPA) incidence, case-mix index, and rapid response team dose trends.
(a) Total CPA incidences, (b) preventable CPA incidences, (c) case-mix index, and (d) rapid response team dose (i.e., rapid response system activation per 1000 admissions). IRR: Incidence rate ratio, CI: confidence interval. *Estimated by the Poisson regression model. †Estimated by a linear regression model.
Fig 2
Fig 2. The number of cardiopulmonary arrests over 24 hours.
(a) Total cardiopulmonary arrests; (b) Preventable cardiopulmonary arrests. RRS: rapid response system, CPA: cardiopulmonary event.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007; 33:237–245. doi: 10.1007/s00134-006-0326-z . - DOI - PubMed
    1. Hodgetts TJ, Kenward G, Vlackonikolis I, Payne S, Castle N, Crouch R, et al.. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002; 54:115–123. doi: 10.1016/s0300-9572(02)00098-9 . - DOI - PubMed
    1. Choi Y, Kwon IH, Jeong J, Chung J, Roh Y. Incidence of Adult In-Hospital Cardiac Arrest Using National Representative Patient Sample in Korea. Healthc Inform Res. 2016; 22:277–284. doi: 10.4258/hir.2016.22.4.277 . - DOI - PMC - PubMed
    1. Andersen LW, Kim WY, Chase M, Berg KM, Mortensen SJ, Moskowitz A, et al.. The prevalence and significance of abnormal vital signs prior to in-hospital cardiac arrest. Resuscitation. 2016; 98:112–117. doi: 10.1016/j.resuscitation.2015.08.016 . - DOI - PMC - PubMed
    1. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation. 2018; 128:191–197. doi: 10.1016/j.resuscitation.2018.05.013 . - DOI - PMC - PubMed

Publication types