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Elizabeth A. Hunt, MD, MPH; Karen P. Zimmer, MD, MPH; Michael L. Rinke, MD; Nicole A. Shilkofski, MD; Carol Matlin, MS, RN; Catherine Garger, RN, BSN; Conan Dickson, MPH, PhD; Marlene R. Miller, MD, MSc

Arch Pediatr Adolesc Med. 2008;162(2):117-122.

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.

Author Affiliations: Departments of Pediatrics (Drs Hunt, Zimmer, Rinke, and Miller) and Anesthesia and Critical Care Medicine (Drs Hunt and Shilkofski), Johns Hopkins School of Medicine; Department of Pediatrics, Johns Hopkins Hospital (Mss Matlin and Garger); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (Drs Dickson and Milller), Baltimore, Maryland.

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