Abstract P103: Dedicated Cardiac Medical Emergency Team for Emergency Cardiac Care of Patients With Cardiovascular Disease
OBJECTIVE On 10/11/08, the Cleveland Clinic Heart and Vascular Institute (HVI) initiated a dedicated “Cardiac Medical Emergency Team” (CMET) for all cardiovascular patients requiring emergency cardiac care (ECC) including urgent medical evaluation and resuscitation for cardiopulmonary arrest (CPA) or acute respiratory compromise (ARC). CMET consists of a Critical Care Staff, Cardiology Fellow, Cardiothoracic Surgical Fellow, Respiratory Therapist, and 2 Critical Care Nurses. All CMET members have current ACLS training. Monthly ACLS Mock Codes are performed on individual units for systematic integration of ACLS into HVI care. The purpose of this study was to characterize CPA in-hospital outcomes after resuscitation by a dedicated CMET.
METHODS In this prospective study of adult (>18 yo) HVI in-patients from 10/11/08 to 6/1/09, CPA was defined as resuscitation requiring chest compressions or defibrillation. ARC and pre-CPA “Do Not Resuscitate” patients were excluded.
RESULTS During the study period, CMET responded to 770 events including 95 CPA. Of these, 60 (63.2%) occurred in an intensive care unit (ICU) and 35 (36.8%) in a non-ICU setting. CPA classification of events included 23 (24.2%) pulseless ventricular tachycardia (PVT), 24 (25.2%) ventricular fibrillation (VFIB), 31 (32.6%) pulseless electrical activity (PEA), and 17 (17.9%) asystole (ASYS). In 95 CPA patients, 76 (80.0%) had ROSC and 53 (55.8%) underwent successful hospital DC. Of 60 ICU CPA patients, 43 (71.7%) had return of spontaneous circulation (ROSC) and 31 (51.7%) had hospital DC. Of 35 non-ICU patients, 33 (94%) had ROSC and 22 (62.9%) had hospital DC.
CONCLUSIONS We have designed a novel multidisciplinary CMET with extensive expertise dedicated to the emergent care of patients with cardiovascular disease. Our results suggest that CMET, when integrated with continuous system wide ACLS training, may enhance outcomes following CPA in patients with cardiovascular disease.