Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center

Objectives: To study the effect of an intervention on prevention of respiratory arrest and cardiopulmonary arrest ( CPA) and to characterize ward CPAs by preceding signs and symptoms and initial cardiac rhythm. Design: A before-and-after interventional trial ( 12 months preintervention and 12 months postintervention). Setting: A tertiary care, academic children's hospital. Participants: Admitted patients who subsequently had either the code team or pediatric medical emergency team ( PMET) called or who had a respiratory arrest or CPA on the wards. Intervention: Transition from a traditional code team to a PMET that responds to clinically deteriorating children in noncritical care areas. Outcome Measures: Combined rate of respiratory arrests and CPAs, rate of CPAs, and rate of respiratory arrests on the wards and agreement between independent reviewers on categorization of CPAs. Results: There was no change in the rate of CPAs on the wards. However, there was a 73% decrease in the incidence of respiratory arrests ( 0.23 respiratory arrests/ 1000 patient-days pre-PMET vs 0.06 post-PMET, P=.03). There was 100% agreement between reviewers on categorization of CPAs. Conclusions: Transition to a PMET was not associated with a change in CPAs but was associated with a significant decrease in the incidence of ward respiratory arrests. We also describe children who may have benefited from the PMET but whose data were not captured by current outcome measures. Finally, we present a new method for categorization of ward CPAs based on preceding signs and symptoms and initial cardiac rhythm.