Systems to prevent in-hospital cardiac arrest

The outcome of cardiac arrest in hospitalized infants and children is poor. However, cardiac arrest is often predictable based on many hours of hypoxaemia, hypotension and associated symptoms and signs (heart rate, respiratory rate, respiratory effort, neurological change) and staff concern. If intensive expert medical and nursing interventions are provided quickly before cardiac arrest, some deaths on wards outside the intensive care environment are preventable. Over the past decade, the introduction of rapid response and early warning systems in some large paediatric hospitals has reduced the incidence of unexpected cardiac arrest by some 40% and death by 20%. These systems enable any staff member (or parent) to summon urgent expert assistance to the patient’s bedside without the need to consult senior staff members. Introduction of a system is a culture change necessitating institutional adoption, extensive education in recognition of the seriously-ill patient, and abolition of hierarchical barriers to obtain rapid assistance.