Der vermeidbare Tod auf der Normalstation

Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias.

Downey AW, Quach JL, Haase M, et al.                                                                                                                    Crit Care Med 2008; 36:477-81

Department of Intensive Care, Austin Hospital, University of Melbourne, Australia.

OBJECTIVE: To describe the characteristics and outcomes of patients receiving a medical emergency team (MET) review for the MET syndromes of acute change in conscious state or arrhythmia and to assess the effect of delayed MET activation on their outcomes.
DESIGN: Retrospective analysis of medical records.
SETTING: University teaching hospital.
PATIENTS: Two cohorts of 100 patients for each of the MET syndromes of acute change in conscious state or arrhythmia.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: We collected information on patient demographics, comorbidities and presence of sepsis, hypovolemia, cardiogenic shock and patient out­come. We also documented the presence and duration of delayed MET activation. The median age for both syndromes was >70 yrs, and major comorbidities were present in >10% of patients. A history of ischemic heart disease (p < .001) and congestive cardiac failure (p = .007) was more common in patients with arrhythmias. Cardiogenic shock and sepsis were common underlying causes of the MET calls for the two groups. However, cardiogenic shock was more common in patients with arrhythmias (p < .001). Hospital mortality was 35% for patients with an acute change in conscious state, compared with 18% for patients with arrhythmias (p = .01). Delayed MET activation occurred in 35% of acute change in conscious state patients and in 24% of arrhythmia patients (p = .09) with a median duration of delay of 16 and 13 hrs, respectively. Delayed MET activation was associated with increased mortality (odds ratio 3.1, 95% confidence interval 1.4-6.6, p = .005).
CONCLUSIONS: An acute change in conscious state leading to a MET call carried a greater risk of death than activation due to arrhythmias. Delayed activation was common for both syndromes and was independently associated with an increased risk of death.