Cardiorespiratory Arrests and Rapid Response Teams in Pediatrics

To the Editor: The study by Dr Sharek and colleagues¹ demonstrated that the introduction of a rapid response team (RRT) at an academic children's hospital was associated with a reduction in hospitalwide mortality and code rate outside of the pediatric intensive care unit. Although these outcomes are commendable, the success of the RRT in this study also highlighted deficiencies in pediatric life support skills among general ward staff. For example, in 38.5% of activations of the RRT, the action deemed by members of the team to be most critical to stabilization or improvement of the patient's status was respiratory support. In the majority of cases, this consisted of basic airway support while for a minority it included administration of a few positive pressure breaths with a bag valve mask. It is disappointing that, in a hospital with a higher proportion of children at risk for codes, general ward staff were unable to deliver these simple potentially life-saving interventions.

Unfortunately, such deficiencies in the recognition and management of acutely ill ward patients are not unique. In the United Kingdom, a national survey demonstrated serious inadequacies in the ward management of the airway, breathing, circulation, monitoring, and oxygen therapy of acutely ill patients requiring admission into the intensive care unit.² There appears to be an inverse relationship between the success of an RRT and the resuscitation capabilities of the wards in that hospital. Proponents of rapid response systems may argue that the RRT is ideally placed to collect data to investigate this and other relevant hypotheses as well as provide appropriate care.³ However, there may be alternative approaches to achieving these objectives, for example, by incorporating specialist critical care courses into physician and nurse training programs and by reorganizing medical services so that senior physicians are always readily available to review patients who are deteriorating.⁴ As yet, the effectiveness of rapid response systems remains unclear.⁵ In our opinion, the major lesson to be drawn from the study by Sharek et al is that staff on general wards need to improve their resuscitation skills.