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Paediatric cardiac rapid response systems: a survey of multicentre practices

Published online by Cambridge University Press:  19 August 2021

Aarti C. Bavare Open the ORCID record for Aarti C. Bavare [Opens in a new window] ,
Natasha S. Afonso ,
Kerry A. Sembera ,
Jason R. Buckley ,
Tia T. Raymond Open the ORCID record for Tia T. Raymond [Opens in a new window] ,
Angela McKeta Open the ORCID record for Angela McKeta [Opens in a new window]  and
John M. Costello
Aarti C. Bavare*
Affiliation:
Department of Paediatrics, Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
Natasha S. Afonso
Affiliation:
Department of Paediatrics, Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
Kerry A. Sembera
Affiliation:
Cardiac Critical Care, Texas Children’s Hospital, Houston, TX, USA
Jason R. Buckley
Affiliation:
Department of Paediatrics, Medical University of South Carolina College of Medicine, MUSC Children’s Hospital, Charleston, SC, USA
Tia T. Raymond
Affiliation:
Department of Paediatrics, Cardiac Critical Care, Medical City Children’s Hospital, Dallas, TX, USA
Angela McKeta
Affiliation:
Department of Paediatrics, Medical University of South Carolina College of Medicine, MUSC Children’s Hospital, Charleston, SC, USA
John M. Costello
Affiliation:
Department of Paediatrics, Medical University of South Carolina College of Medicine, MUSC Children’s Hospital, Charleston, SC, USA
*
Author for correspondence: A.C. Bavare, MD, MPH, Department of Paediatrics, Critical Care Medicine, Baylor College of Medicine, 6651 Main Street, MC: E1480.52, Houston, TX 77030, USA. Tel: 8328266257; Fax: 8328264252. E-mail: acbavare@texaschildrens.org
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Abstract

Introduction:

While the efficacy and guidelines for implementation of rapid response systems are well established, limited information exists about rapid response paradigms for paediatric cardiac patients despite their unique pathophysiology.

Methods:

With endorsement from the Paediatric Cardiac Intensive Care Society, we designed and implemented a web-based survey of paediatric cardiac and multidisciplinary ICU medical directors in the United States of America and Canada to better understand paediatric cardiac rapid response practices.

Results:

Sixty-five (52%) of 125 centres responded. Seventy-one per cent of centres had ∼300 non-ICU beds and 71% had dedicated cardiac ICUs. To respond to cardiac patients, dedicated cardiac rapid response teams were utilised in 29% of all centres (39% and 5% in centres with and without dedicated cardiac ICUs, respectively) [p = 0.006]. Early warning scores were utilised in 62% of centres. Only 31% reported that rapid response teams received specialised training. Transfers to ICU were higher for cardiac (73%) compared to generalised rapid response events (54%). The monitoring and reassessment of patients not transferred to ICU after the rapid response was variable. Cardiac and respiratory arrests outside the ICU were infrequent. Only 29% of centres formally appraise critical deterioration events (need for ventilation and/or inotropes post-rapid response) and 34% perform post-event debriefs.

Conclusion:

Paediatric cardiac rapid response practices are variable and dedicated paediatric cardiac rapid response systems are infrequent in the United States of America and Canada. Opportunity exists to delineate best practices for paediatric cardiac rapid response and standardise practices for activation, training, patient monitoring post-rapid response events, and outcomes evaluation.

Keywords

Rapid response teamspaediatriccardiac critical careclinical outcomescardiac arrest
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 6 , June 2022 , pp. 944 - 951
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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