Commentary: Kause J et al. (2004). A comparison of antecedents to cardiac arrest, deaths and emergency intensive care admissions in Australia and ANZ, and the UK – the ACADEMIA study (original) (raw)

Abstract

Many patients have physiological deterioration prior to cardiac arrest, death and intensive care unit (ICU) admission that are detected and documented by medical and nursing staff. Appropriate early response to detected deterioration is likely to benefit patients. In a multi-centre, prospective, observational study over three consecutive days, we studied the incidence of antecedents (serious physiological abnormalities) preceding primary events (defined as in-hospital deaths, cardiac arrests and unanticipated ICU admissions) in 90 hospitals [69 UK, 19 Australia and two New Zealand (ANZ)]. Sixty-eight hospitals reported primary events during the 3-day study period (50 UK, 16 Australia and two ANZ). Data on the availability of ICU/high-dependency unit (HDU) beds and cardiac arrest teams and medical emergency teams (METs) were also collected. Of 638 primary events, there were 308 (48.3%) deaths, 141 (22.1%) cardiac arrests and 189 (29.6%) unplanned ICU admissions. There were differences in the pattern of primary events between the UK and ANZ (P < 0.001). There were proportionally more deaths in the UK (52.3% versus 35.3%) and a higher number of unplanned ICU admissions in ANZ (47.3% versus 24.2%). Sixty per cent (383) of primary events had a total of 1032 documented antecedents. The most common antecedents were hypotension and a fall in Glasgow Coma Scale. The proportion of ICU/HDU to general hospital beds was greater in ANZ (0.034 versus 0.016, P < 0.001) and METs were more common in ANZ (70.0% versus 27.5%, P = 0.001). The data confirm antecedents are common before death, cardiac arrest and unanticipated ICU admission. The study also shows differences in patterns of primary events, the provision of ICU/HDU beds and resuscitation teams, between the UK and ANZ. Future research, focusing upon the relationship between service provision and the pattern of primary events, is suggested.

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References (5)

  1. Department of Health. (2000). Comprehensive Critical Care: A Review of Adult Critical Care Services. London: HMSO.
  2. Goldhill D, Schein M, Worthing L, Mulcahy A, Tarling M, Summer A. (1999). Physiological values and procedures in the 24 hours before ICU admission from the ward. Anaesthesia; 54: 853-860.
  3. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K. (2004). A comparison of antecedents to cardiac arrests, death, and emergency intensive care admissions in Australia, New Zealand and the United Kingdom -the ACADEMIA study. Resuscitation; 62: 275-282.
  4. Lee A, Bishop G, Hillman K, Daffurn K. (1995). The medical emergency team. Anaesthesia Intensive Care; 23: 183-186.
  5. McQuillan P, Pilkinton S, Allan A, Taylor B, Short A, Morgan G, Neilson M, Barrett D, Smith G, Collins G. (1998). Confidential enquiry into quality of care before admission to intensive care. British Medical Journal; 316: 1853-1858. National Confidential Enquiry into patient Outcome and Death. (2005). An Acute Problem? A Report of the National Confidential Enquiry into Patient Outcome and Death. London: NCEPOD. National Institute for Health and Clinical Excellence. (2007). Acutely Ill Patients in Hospital: Recognition of and Responses to Acute Illness in Adults in Hospital. NICE Clinical Guideline 50. London: NICE. National Patient Safety Agency. (2007). Safer Care for Acutely Ill Patients: Learning from Serious Incidents. London: NPSA.