Race is not Associated with Medical Emergency Team Evaluation Prior to In-Hospital Cardiac Arrest

Background

Black patients have worse outcomes after in-hospital cardiac arrest (IHCA). Whether these racial disparities are associated with medical emergency team (MET) evaluation prior to IHCA remains unknown.

Methods

A retrospective cohort study of adults age ≥ 18 years from the American Heart Association Get With The Guidelines® Resuscitation registry who had an IHCA between 2000 and 2021 with acute physiologic decline (modified early warning score [MEWS] ≥ 3) during the 24 hours prior to IHCA. A propensity-weighted cohort was constructed to balance confounders between Black and White patients. The association between race and MET evaluation was quantified with weighted multivariable logistic regression.

Results

Among 354,480 patients, 88,507 met the initial inclusion criteria, of which 29,714 patients (median age 69 [IQR 58-79] years, 42.5% female, and 26.9% Black) had acute physiologic decline during the 24 hours prior to IHCA. Among patients with acute physiologic decline, 4102 (13.8%) patients had a preceding MET evaluation before IHCA. Rates of MET evaluation prior to cardiac arrest did not differ significantly between Black and White patients with acute physiologic decline (aOR 1.02, 95% CI 0.94-1.11, p = 0.62).

Conclusions

Though racial disparities in IHCA outcomes exist, this study did not detect a difference in rates of MET evaluation prior to IHCA among patients with acute physiologic decline as a potential mechanism for these disparities.

Clinical Perspective What Is New?

• With the goal to identify potential mechanisms leading to racial disparities in outcomes from adult in-hospital cardiac arrest (IHCA), this multicenter prospective observational study is the first study to analyze the association between race and medical emergency team (MET) evaluation among patients with evidence of clinical deterioration. IHCA

• We found that rates of MET evaluation among patients with clinical deterioration (i.e., vital sign abnormalities) prior to IHCA did not differ between Black and White patients.

What Are the Clinical Implications?

• These data demonstrate that race is not associated with MET evaluation prior to adult in-hospital cardiac arrest.

• Future studies should evaluate other links in the American Heart Association’s in-hospital chain of survival (e.g., resuscitation quality, post-arrest care) as potential targets to mitigate racial disparities in IHCA survival.