Abstract 188: Pediatric Medical Emergency Team Response and Outcomes: A Report of 4,181 Events From the AHA Get With the Guidelines®-Resuscitation Registry

Abstract

Background: In-hospital cardiac arrest (CA) is often preceded by signs and symptoms that predict subsequent deterioration. In response, hospitals created Medical Emergency Teams (METs) to bring skilled resources to the bedside with the aim of improving outcomes. Objective: Describe a cohort of pediatric MET events from the AHA Get With the Guidelines-Resuscitation (GWTG-R) registry. Methods: We analyzed consecutive pediatric (< 18 yrs) MET events submitted to the AHA GWTG-R from Jan 2006 - Feb 2012. We excluded MET events in outpatient, critical care, newborn nurseries, delivery rooms, emergency departments (ED) and interventional/diagnostic areas. Results: We identified 4,181 MET events from 170 U.S. hospitals: median age 3.0 yrs (IQR = 0.0-13.0) with 52% male. Majority of MET events were in general inpatient wards (N = 3136, 75%) and telemetry/step-down units (N = 580, 13%). Medical (71%) and surgical (15%) non-cardiac patients were most frequent. Median length of MET event was 29.0 mins (IQR = 17.0-47.0). Most frequent triggers included: decreased oxygen saturation (30%), difficulty breathing (24%), staff concern (23%), tachypnea (21%), mental status changes (16%), and respiratory depression (12%). Within 24 hrs prior to MET call, 15% were transferred from an ICU, and 22% were admitted from the ED. Frequent non-drug interventions included: oxygen (58%), peripheral IV placement (30%), CXR (16%), suctioning (15%), and ICU consult (12%). Frequent drug interventions included: fluid bolus (21%), inhaled bronchodilators (16%), and anti-epileptics (7%). Almost half were transferred to the ICU (n = 2022, 48%), 236 (6%) progressed to require emergency assisted ventilation, and 18 patients (0.43%) progressed to CA. Survival to discharge was 92% (N = 3789). Conclusions: MET events occurred in general inpatient wards for objective indications, included assisted ventilation or CPR in 6.4%, and were associated with 8% hospital mortality. After treatment in 87% of events, 39% remained on inpatient wards, suggesting MET associated treatments may have stabilized or improved the condition of children judged to be clinically deteriorating by ward staff. Frequent events after ED admission or ICU transfer may represent an opportunity to improve the system of care.