Hospital rapid response systems aim to stop preventable cardiac arrests, but defining preventability is a challenge. We developed a multidisciplinary consensus-based process to determine in-hospital cardiac arrest (IHCA) preventability based on objective measures. We developed an interdisciplinary ward IHCA debriefing program at an urban quaternary-care academic hospital. This group systematically reviewed all IHCAs weekly, reaching consensus determinations of the IHCA’s cause and preventability across three mutually exclusive categories: 1) unpredictable (no evidence of physiologic instability < 1 h prior to and within 24 h of the arrest), 2) predictable but unpreventable (meeting physiologic instability criteria in the setting of either a poor baseline prognosis or a documented goals of care conversation) or 3) potentially preventable (remaining cases). Of 544 arrests between 09/2015 and 11/2023, 339 (61%) were deemed predictable by consensus, with 235 (42% of all IHCAs) considered potentially preventable. Potentially preventable arrests disproportionately occurred on nights and weekends (70% vs 55%, p = 0.002) and were more frequently respiratory than cardiac in etiology (33% vs 15%, p < 0.001). Despite similar rates of ROSC across groups (67–70%), survival to discharge was highest in arrests deemed unpredictable (31%), followed by potentially preventable (21%), and then those deemed predictable but unpreventable which had the lowest survival rate (16%, p = 0.007). Our IHCA debriefing procedures are a feasible and sustainable means of determining the predictability and potential preventability of ward cardiac arrests. This approach may be useful for improving quality benchmarks and care processes around pre-arrest clinical activities.

中文翻译：

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一种新颖的结构化报告程序，用于一致确定院内心脏骤停的可预测性和可预防性

医院快速反应系统旨在阻止可预防的心脏骤停，但定义可预防性是一个挑战。我们开发了一个基于多学科共识的流程，根据客观措施确定院内心脏骤停 (IHCA) 的可预防性。我们在一家城市四级护理学术医院制定了跨学科病房 IHCA 汇报计划。该小组每周系统地审查所有 IHCA，在三个相互排斥的类别中就 IHCA 的原因和可预防性达成共识：1）不可预测（逮捕前 1 小时内和逮捕后 24 小时内没有生理不稳定的证据），2）可预测但不可预防（在基线预后不良或记录的护理对话目标的情况下满足生理不稳定标准）或 3）可能可预防（其余病例）。在 2015 年 9 月至 2023 年 11 月期间的 544 起逮捕中，有 339 起（61%）被认为是可以预测的，有 235 起（占所有 IHCA 的 42%）被认为是可以预防的。潜在可预防的逮捕不成比例地发生在夜间和周末（70% vs 55%，p = 0.002），并且从病因学角度来看，呼吸系统比心脏疾病更常见（33% vs 15%，p < 0.001）。尽管各组的 ROSC 率相似（67-70%），但出院存活率在被认为不可预测的逮捕中最高（31%），其次是潜在可预防的（21%），然后是被认为可预测但不可预防的存活率最低的逮捕（16%，p = 0.007）。我们的 IHCA 汇报程序是确定病房心脏骤停的可预测性和潜在可预防性的可行且可持续的方法。这种方法可能有助于改善逮捕前临床活动的质量基准和护理流程。