Aim
The vast majority of in-hospital cardiac arrests are preceded by a period of physiological deterioration (Deakin et al 2010). It has been suggested that as many as 75% of all in-hospital cardiac arrests could be prevented (NCEPOD 2012), and that a third of all potentially preventable deaths in the UK occur as a result of poor clinical monitoring (Hogan et al 2012). There is no doubt that NEWS has reduced the number of unplanned ICU admissions (Greengross et al 2014), however there is an increasing body of evidence highlighting varying performance of the NEWS system to reduce adverse events (Bedoya et al 2020; Haegdoorens et al 2020). The aim of this study is to identify additional antecedents to cardiac arrests and develop a cardiac arrest prediction tool to assist in the earlier recognition of physiological deterioration. The data provided forms the basis of the authors PhD project.
Method
Each in-hospital cardiac arrest was reported via an electronic system. Patients notes were reviewed by a member of the Resuscitation Service within 72 hours to look at numerous parameters, adopting recommendations made by NCEPOD 2012, including the last documented NEWS2 score prior to the cardiac arrest (maximum of 2 hours before). Data was also gathered on harm events prior to the arrest in line with the Global Trigger Tool (GTT). A data collection form was devised to capture this data and other aspects relevant to the study. This data was then further analysed looking for any trends, or themes relating to physiological deterioration prior to cardiac arrest.
Results
The following data was obtained from all adult in-hospital cardiac arrests from April 2021-March 2022:
35% of patients had a NEWS2 score of 0-2 prior to arrest
62% of patients had a NEWS2 score of 0-4 prior to arrest
38% of patients had a NEWS2 score of 5+ prior to arrest
24% of patients had a biochemical signs of Acute Kidney Injury (AKI) prior to arrest
22% of patients had a raised Troponin prior to arrest
20% of patients had both a raised Troponin and signs of AKI prior to cardiac arrest.
Conclusion
The Trust mandates escalation of a patient once the NEWS2 reaches 5, however the data reviewed showed that 62% of patients who had a cardiac arrest did not reach this number. What was also discovered was that signs of AKI and increased in Troponin were common antecedents. The Trust believes there is an opportunity to introduce a Cardiac Arrest Risk Index that takes into account parameters not currently considered as early warning for acute physiological deterioration. This system could work alongside and complement existing NEWS2 systems, to enhance patient safety.

**Aim**
The vast majority of in-hospital cardiac arrests are preceded by a period of physiological deterioration (Deakin et al 2010). It has been suggested that as many as 75% of all in-hospital cardiac arrests could be prevented (NCEPOD 2012), and that a third of all potentially preventable deaths in the UK occur as a result of poor clinical monitoring (Hogan et al 2012). There is no doubt that NEWS has reduced the number of unplanned ICU admissions (Greengross et al 2014), however there is an increasing body of evidence highlighting varying performance of the NEWS system to reduce adverse events (Bedoya et al 2020; Haegdoorens et al 2020). The aim of this study is to identify additional antecedents to cardiac arrests and develop a cardiac arrest prediction tool to assist in the earlier recognition of physiological deterioration. The data provided forms the basis of the authors PhD project.
**Method**
Each in-hospital cardiac arrest was reported via an electronic system. Patients notes were reviewed by a member of the Resuscitation Service within 72 hours to look at numerous parameters, adopting recommendations made by NCEPOD 2012, including the last documented NEWS2 score prior to the cardiac arrest (maximum of 2 hours before). Data was also gathered on harm events prior to the arrest in line with the Global Trigger Tool (GTT). A data collection form was devised to capture this data and other aspects relevant to the study. This data was then further analysed looking for any trends, or themes relating to physiological deterioration prior to cardiac arrest.
**Results**
The following data was obtained from all adult in-hospital cardiac arrests from April 2021-March 2022:
**35%** of patients had a NEWS2 score of 0-2 prior to arrest
**62%** of patients had a NEWS2 score of 0-4 prior to arrest
**38%** of patients had a NEWS2 score of 5+ prior to arrest
**24%** of patients had a biochemical signs of Acute Kidney Injury (AKI) prior to arrest
**22%** of patients had a raised Troponin prior to arrest
**20%** of patients had both a raised Troponin and signs of AKI prior to cardiac arrest.
**Conclusion**
The Trust mandates escalation of a patient once the NEWS2 reaches 5, however the data reviewed showed that **62%** of patients who had a cardiac arrest did not reach this number. What was also discovered was that signs of AKI and increased in Troponin were common antecedents. The Trust believes there is an opportunity to introduce a Cardiac Arrest Risk Index that takes into account parameters not currently considered as early warning for acute physiological deterioration. This system could work alongside and complement existing NEWS2 systems, to enhance patient safety.

Is NEWS2 old news? A updated review of physiological deterioration prior to adult cardiac arrest at an acute NHS Trust in Essex, UK

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

On 16 and 17 June, we are organising our first-ever hybrid congress. You will be able to join us live at the beautiful conference venue in Antwerp, Belgium and present your Poster. 

We are happy to welcome you to Resuscitation 2022!