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Narrative Review10-02-2025
Rapid Response Teams in low and middle-income countries: a scoping review
Critical Care Science. 2025;37:e20250155
Abstract
Narrative ReviewRapid Response Teams in low and middle-income countries: a scoping review
Critical Care Science. 2025;37:e20250155
DOI 10.62675/2965-2774.20250155
Views64ABSTRACT
Background
Rapid Response Teams have been widely implemented in high-income countries and play a crucial role in the early identification and management of clinically deteriorating patients. However, their implementation in low and middle-income settings has not been adequately described. Our goal was to map the current evidence in this setting.
Methods
We conducted a scoping review to map the published literature about Rapid Response Teams in low- and middle-income countries, according to year of publication, study type, team composition, reported outcomes, and potential roles of the team.
Results
After screening 6,679 studies, 52 fulfilled eligibility criteria: 36 full-text studies and 16 conference abstracts. Most of the studies were from Brazil (51.2%), followed by India (19.2%) and Turkey (7.7%), with the two earliest reports being conference abstracts published in 2009. The predominant design was before-and-after studies (20; 38.4%), followed by cohort studies (16; 30.8%). An intensive care unit physician was always a member of the Rapid Response Teams in 55.9% of the studies and an intensive care unit nurse in 23.5%. The number of Rapid Response Teams calls in the before-and-after studies ranged from 2.39 to 124 per 1,000 admissions. Reported outcomes varied, with most studies focusing on mortality (26, 50%) and code blue incidence (21; 40.4%). Four (7.7%) studies reported an active role of Rapid Response Teams in goals of care discussions.
Conclusion
We found that evidence on Rapid Response Teams in low- and middle-income countries remains limited, with a time lag in publications compared to high-income countries. Our findings highlight the need for further studies and policy initiatives to evaluate the effectiveness of implementing Rapid Response Teams in resource-constrained settings.
Keywords:BrazilCardiopulmonary Resuscitationcritical illnessDeveloping countriesGoalsHospital rapid response teamIncidenceintensive care unitsPatient care planningPatient-reported outcome measuresSee more
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Original Article05-21-2025
Cardiopulmonary resuscitation in Brazilian medical television shows: a descriptive and quality assessment study
Critical Care Science. 2025;37:e20250228
Abstract
Original ArticleCardiopulmonary resuscitation in Brazilian medical television shows: a descriptive and quality assessment study
Critical Care Science. 2025;37:e20250228
DOI 10.62675/2965-2774.20250228
Views219ABSTRACT
Objective:
To assess the accuracy of Brazilian television depictions of cardiopulmonary arrest, their management, and outcomes and to compare the observed outcomes with prior data from observational studies.
Methods:
Investigators screened episodes, identified cardiac arrest scenes, collected relevant information, and assessed outcomes. Cardiac arrest scenes were then analyzed using the American Heart Association guidelines. The primary outcome was survival with favorable neurologic outcomes. Secondary outcomes were the return of spontaneous circulation and the number of Advanced Cardiovascular Life Support deviations in each event.
Results:
Fifty-nine cardiac arrests were included in the study. Death occurred in 55.9% of patients, and return of spontaneous circulation was obtained in 54.2%. Survival rate was 44.1%, and 42.4% of the patients had favorable neurologic outcomes. Adherence to Advanced Cardiovascular Life Support guidelines did not demonstrate a significant impact on survival with favorable neurological outcomes, as evidenced by comparable odds ratios (0.86 [95%CI 0.22 - 2.36] for 3 - 5 deviations and 0.69 [95%CI 0.07 - 5.93] for ≥ 6 deviations using 0 - 2 deviations as reference). Television shows depicted a significantly higher proportion of favorable outcomes than real-world Brazilian cohorts for out-of-hospital and in-hospital scenarios (50% versus 20.5%, p = 0.107; and 43.3% versus 17.4%, p < 0.0001, respectively).
Conclusion:
In Brazilian television shows, the portrayal of cardiopulmonary resuscitation is inaccurate and tends to overstate the likelihood of favorable outcomes following cardiac arrests.
Keywords:Cardiopulmonary ResuscitationDeath, sudden, cardiacHeart arrestprognosisQuality of careTelevisionSee more
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Review Article10-14-2019
How to discuss about do-not-resuscitate in the intensive care unit?
Revista Brasileira de Terapia Intensiva. 2019;31(3):386-392
Abstract
Review ArticleHow to discuss about do-not-resuscitate in the intensive care unit?
Revista Brasileira de Terapia Intensiva. 2019;31(3):386-392
DOI 10.5935/0103-507X.20190051
Views107See moreAbstract
The improvement in cardiopulmonary resuscitation quality has reduced the mortality of individuals treated for cardiac arrest. However, survivors have a high risk of severe brain damage in cases of return of spontaneous circulation. Data suggest that cases of cardiac arrest in critically ill patients with non-shockable rhythms have only a 6% chance of returning of spontaneous circulation, and of these, only one-third recover their autonomy. Should we, therefore, opt for a procedure in which the chance of survival is minimal and the risk of hospital death or severe and definitive brain damage is approximately 70%? Is it worth discussing patient resuscitation in cases of cardiac arrest? Would this discussion bring any benefit to the patients and their family members? Advanced discussions on do-not-resuscitate are based on the ethical principle of respect for patient autonomy, as the wishes of family members and physicians often do not match those of patients. In addition to the issue of autonomy, advanced discussions can help the medical and care team anticipate future problems and, thus, better plan patient care. Our opinion is that discussions regarding the resuscitation of critically ill patients should be performed for all patients within the first 24 to 48 hours after admission to the intensive care unit.
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Original Article01-01-2016
Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style
Revista Brasileira de Terapia Intensiva. 2016;28(4):427-435
Abstract
Original ArticleCardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style
Revista Brasileira de Terapia Intensiva. 2016;28(4):427-435
DOI 10.5935/0103-507X.20160076
Views109See moreABSTRACT
Objective:
The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style.
Methods:
This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year.
Results:
The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively.
Conclusions:
The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low.

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Original Article01-01-2015
Therapeutic hypothermia after cardiac arrest: outcome predictors
Revista Brasileira de Terapia Intensiva. 2015;27(4):322-332
Abstract
Original ArticleTherapeutic hypothermia after cardiac arrest: outcome predictors
Revista Brasileira de Terapia Intensiva. 2015;27(4):322-332
DOI 10.5935/0103-507X.20150056
Views64ABSTRACT
Objective:
The determination of coma patient prognosis after cardiac arrest has clinical, ethical and social implications. Neurological examination, imaging and biochemical markers are helpful tools accepted as reliable in predicting recovery. With the advent of therapeutic hypothermia, these data need to be reconfirmed. In this study, we attempted to determine the validity of different markers, which can be used in the detection of patients with poor prognosis under hypothermia.
Methods:
Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6-month outcomes defined according to the Cerebral Performance Categories scale (good 1-2, poor 3-5). Neuron-specific enolase was collected at 72 hours. Imaging and neurophysiologic exams were carried out in the 24 hours after the rewarming period.
Results:
Sixty-seven patients were included in the study, of which 12 had good neurological outcomes. Ventricular fibrillation and electroencephalographic theta activity were associated with increased likelihood of survival and improved neurological outcomes. Patients who had more rapid cooling (mean time of 163 versus 312 minutes), hypoxic-ischemic brain injury on magnetic resonance imaging or neuron-specific enolase > 58ng/mL had poor neurological outcomes (p < 0.05).
Conclusion:
Hypoxic-ischemic brain injury on magnetic resonance imaging and neuron-specific enolase were strong predictors of poor neurological outcomes. Although there is the belief that early achievement of target temperature improves neurological prognoses, in our study, there were increased mortality and worse neurological outcomes with earlier target-temperature achievement.
Keywords:Cardiopulmonary ResuscitationHeart arrestHypothermia inducedHypoxia-ischemia, brainneuron-specific enolaseSee more
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Original Article07-26-2010
Cardiorespiratory arrest diagnosis and treatment: theoretical knowledge evaluation in a general hospital’s physicians
Revista Brasileira de Terapia Intensiva. 2010;22(2):153-158
Abstract
Original ArticleCardiorespiratory arrest diagnosis and treatment: theoretical knowledge evaluation in a general hospital’s physicians
Revista Brasileira de Terapia Intensiva. 2010;22(2):153-158
DOI 10.1590/S0103-507X2010000200009
Views44BACKGROUND: The main causes of cardiopulmonary arrest are endemic, and require constant medical improvement on cardiopulmonary resuscitation techniques. Training and continued education are essential to skilled management of cardiopulmonary resuscitation. OBJECTIVE: This study aimed to evaluate the physicians' theoretical knowledge on diagnosis and treatment of cardiopulmonary arrest. METHODS: This was a cross-sectional descriptive research conducted in a general hospital in Roraima, Brazil. The study population consisted of physicians who worked in the emergency department and intensive care units. The data were collected using a questionnaire addressing the subject. RESULTS: Forty four physicians answered the questionnaire. The mean score was 50% right answers. Most (88.5%) respondents committed "fatal errors". Half of the sample was never trained in advanced life support skills. No correlation was found between the number of right answers and attendance to advanced life support training courses. An inverse correlation was found between performance and age, but no statistically significant correlation was seen regarding performance and time from medical graduation. CONCLUSION: The physicians' theoretical knowledge on this field is worrisome. The results point to the importance of professional advanced life support training in order to assure quality standards for cardiac arrest management in this general hospital.
Keywords:Advanced life supportBasic life supportCardiopulmonary ResuscitationHealth knowledgeHeart arrestSee more
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Review Article07-26-2010
Mild therapeutic hypothermia after cardiac arrest: mechanism of action and protocol development
Revista Brasileira de Terapia Intensiva. 2010;22(2):196-205
Abstract
Review ArticleMild therapeutic hypothermia after cardiac arrest: mechanism of action and protocol development
Revista Brasileira de Terapia Intensiva. 2010;22(2):196-205
DOI 10.1590/S0103-507X2010000200015
Views47See moreCardiac arrest is a high mortality event and the associated brain ischemia frequently causes severe neurological damage and persistent vegetative state. Therapeutic hypothermia is an important tool for the treatment of post-anoxic coma after cardiopulmonary resuscitation. It has been shown to reduce mortality and to improve neurological outcomes after cardiac arrest. Nevertheless, hypothermia is underused in critical care units. This manuscript aims to review the hypothermia mechanism of action in cardiac arrest survivors and to propose a simple protocol, feasible to be implemented in any critical care unit.

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Original Article10-30-2009
Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America
Revista Brasileira de Terapia Intensiva. 2009;21(3):332-335
Abstract
Original ArticleUse of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America
Revista Brasileira de Terapia Intensiva. 2009;21(3):332-335
DOI 10.1590/S0103-507X2009000300015
Views46See moreThis case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an automated external defibrillator (AED) with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-of-hospital services and stresses the desirability of adopting policies for public access to early defibrillation.




