Paediatric rapid response systems:: A literature review

Background: Paediatric cardiorespiratory arrest carries a poor prognosis. The most common cause is respiratory insufficiency or hypotension/shock, which can be reversible. The use of RRSs in adult hospitals that proactively intervene when signs of physiological instability occur is widespread and increasing although the level of evidence for their efficiency is a matter of debate. Methods: A systematic literature review was undertaken to evaluate and summarise the current knowledge about paediatric RRSs. Results: Paediatric RRSs are in use in several places around the world. One study shows a statistically significant decrease in mortality rate after implementation. Two studies show a non-significant association with decreased mortality rate. Cardiac and/or respiratory arrest rates decreased in all four before-after studies with statistical significance in two. Conclusions: Cardiac arrest and death are rare in paediatric hospitals, which can in part explain the difficulties to demonstrate statistically significant benefits. There are also specific problems regarding calling criteria due to age related physiological diversity as well as chronic disease.