An interesting survey recently published in Resuscitation looks at arrest teams for in-hospital cardiac arrest. As anyone in the FOAM-o-sphere is well aware, trauma teams, prehospital teams and ED cardiac arrest teams are increasingly well oiled and the importance of a designated team leader has never been more apparent. Are teams for in-hospital arrests lagging behind? Is the in-hospital arrest the neglected problem child in the resus family?
This is a nationwide cross-sectional study in which the authors surveyed 44 inpatient hospitals in Denmark and examined their hospital protocols for in-house arrests. They looked primarily at the composition of arrest teams for in-hospital arrest and whether or not the team leader and other roles were defined.
The results are fairly interesting on two fronts. Firstly the teams dispatched to take care of the sickest of the sick are really pretty junior. A senior trainee (defined here as PGY3 and up) was involved in only 20% of the teams and the rest of the time the doctors running the codes had less than 2 years of experience. The second finding of note was that in 41% of the hospitals, no team leader was defined pre-arrest, and the majority didn’t define the roles of any of the other team members either. The teams comprised an average of 5 people, including doctors from anesthesiology, cardiology and internal medicine, anaesthesia nurses, orderlies and medical assistants.
A few musings
I suspect that these findings are in no way unique to Denmark and are definitely similar to the way things happen in a number of the countries in which I’ve worked. In many facets of hospital medicine ’sickness’ and seniority are directly proportional, i.e the more risk you have of dying imminently, the more experienced people you need looking after you. Why then do we often send our most junior docs to treat patients who arrest within the walls of the hospital, when we have senior shot-callers running codes in the ED, trauma bay and ICU? Would we accept a trauma team in 2015 without a predefined leader? Another interesting point is that in-hospital arrest teams in general are made up of staff from a range of specialities, who don’t work together on a regular basis.
Structure and leadership – as well as initiating possible advanced interventions outside the algorithm – would all be better taken care of in a timely fashion with more experienced team members present from the start. Maybe it’s time that we started structuring and drilling our in-hospital arrest teams in the same way we do our other high performance teams?
Resuscitation. 2015 Apr;89:123-8. doi: 10.1016/j.resuscitation.2015.01.014. Epub 2015 Jan 21.
Organisation of in-hospital cardiac arrest teams – a nationwide study.
Lauridsen KG1, Schmidt AS1, Adelborg K2, Løfgren B3.