Improving Pediatric Survival from Resuscitation Events: The Role and Organization of Hospital-based Rapid Response Systems and Code Teams

During the past 10-15 years it has become evident that in spite of the sophistication of medicine, hospitalized patients frequently experience cardiac arrests from which the majority do not survive. A substantial number of these arrests occur on general inpatient units where patients begin to deteriorate but there is a failure of timely recognition so that appropriate intervention can be instituted before the arrest takes place. Much work has been done to determine how survival from adult in-hospital cardiac arrests can be improved by (1) teaching health care providers about resuscitation management using a team approach and (2) more recently, by developing rapid response systems to recognize deteriorating patients early and intervening to prevent the cardiac arrest. The purpose of this review is to outline what is known about the use and organization of resuscitation teams (code teams) and rapid response systems as they apply to pediatric patients. Effort has been made to include the most current pediatric science available as a basis for encouraging the ongoing implementation of hospital team-based systems which appear to be able to improve the outcomes of pediatric in-hospital cardiac and respiratory arrests. Practical suggestions, implementation strategies, potential barriers, and ways to integrate pediatric code teams and rapid response systems into the quality and safety fabric of the hospital are provided.