Triggers for medical emergency team activation after non-cardiac surgery

• Published in: Anaesthesia and intensive care Vol. 51; no. 4; pp. 281 - 287
• Main Authors: Douglas, Ned WR, Coleman, Olivia M, Steel, Amelia CA, Leslie, Kate, Darvall, Jai NL
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA SAGE Publications 01.07.2023; Sage Publications Ltd
• Subjects: Adult; Cardiac arrhythmia; Emergency medical care; Emergency medical technicians; Hospital Mortality; Hospital Rapid Response Team; Hospitalization; Humans; Hypotension; Hypotension - epidemiology; Intensive care; Intensive Care Units; Patients; Postoperative period; Prevention; Retrospective Studies; Surgery; Tachycardia; Tertiary Care Centers; failure to rescue; rapid response teams; deterioration; Surgery; anaesthesia; medical emergency teams
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X221141107

Deterioration after major surgery is common, with many patients experiencing a medical emergency team (MET) activation. Understanding the triggers for MET calls may help design interventions to prevent deterioration. We aimed to identify triggers for MET activation in non-cardiac surgical patients. A retrospective cohort study of adult patients who experienced a postoperative MET call at a single tertiary hospital was undertaken. The trigger and timing of each MET call and patient characteristics were collected. Four hundred and one MET calls occurred after 23,258 surgical procedures, a rate of 1.7% of all non-cardiac surgical procedures, accounting for 11.7% of all MET calls over the study period. Hypotension (41.4%) was the most common trigger, followed by tachycardia (18.5%), altered conscious state (11.0%), hypoxia (10.0%), tachypnoea (5.7%), 'other' (5.7%), clinical concern (4.0%), increased work of breathing (1.5%) and bradypnoea (0.7%). Cardiac and/or respiratory arrest triggered 1.2% of MET activations. Eighty-six percent of patients had a single MET call, 10.2% had two, 1.8% had three and one patient (0.3%) had four. The median interval between post-anaesthetic care unit (PACU) discharge and MET call was 14.7 h (95% confidence interval 4.2 to 28.9 h). MET calls resulted in intensive care unit (ICU) admission in 40 patients (10%), while 82% remained on the ward, 4% had a MET call shortly after ICU discharge and returned there, 2% returned to theatre, and 2% went to a high dependency unit. Hypotension was the most common trigger for MET calls after non-cardiac surgery. Deterioration frequently occurred within 24 h of PACU discharge. Future research should focus on prevention of hypotension and tachycardia after surgery.