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March 26, 2008

Cardiorespiratory Arrests and Rapid Response Teams in Pediatrics

JAMA. 2008;299(12):1423-1424. doi:10.1001/jama.299.12.1423-b

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.

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