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Peri-operative medical emergency team activation in liver transplantation
  1. Ambica Parmar1,
  2. Glenda Meeberg2,
  3. David Bigam2,
  4. Heather Richardson1,
  5. R T Noel Gibney1,
  6. Sean M Bagshaw1
  1. 1Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
  2. 2Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
  1. Correspondence to Dr Sean M Bagshaw, Division of Critical Care Medicine, University of Alberta Hospital, 3C1.12 Walter C. Mackenzie Centre, 8440-122 Street, Edmonton, Alberta T6G2B7 Canada; bagshaw{at}ualberta.ca

Abstract

Background The medical emergency team (MET) system functions to promptly identify acutely ill patients at-risk for deterioration. Liver transplant (LT) patients are at-risk for serious post-operative complications.

Objective To evaluate the characteristics of MET activations in post-operative LT patients and to compare clinical outcomes with case-matched controls.

Methods Retrospective case–control study of all adult patients receiving LT over a 3-year period. Cases were defined as post-operative LT patients who received a MET activation. Controls were defined as LT patients who did not receive a MET activation during the same period, and were matched for age, sex and pre-operative Model for End-Stage Liver Disease (MELD) score.

Results We found 10.3% (n=18) of LT patients received a total of 26 MET activations (149.4 per 1000 admissions). The mean (SD) age was 54 (9.5) years and 52% were females. There were no differences in baseline characteristics or underlying liver disease between groups, except pre-operative hepatic encephalopathy was more common among cases (55.6% vs 22.2%, p=0.03). Of the MET activations, respiratory distress was the most common ‘trigger’ (87.7%). In 42.3% (n=11) of the activations, MET criteria had been fulfilled in the 24 h preceding. In these MET activations, patients were characterised as tachypnoeic, hypoxaemic, hypotensive, tachycardic and/or oligo-anuric. MET patients had significantly longer ICU and hospital lengths of stay, along with greater rate of unplanned ICU re-admission (83.3% vs 13.9%, p<0.0001) compared with controls. MET patients also had higher in-hospital and 1-year post-discharge mortality (p=0.10, <0.001, respectively) compared with controls.

Conclusions LT patients with post-operative complications prompting MET activation had higher morbidity and mortality compared with controls; however, the MET may have been under-utilised and/or delayed. Further prospective multi-centre investigation is warranted.

  • Liver transplant
  • medical emergency team
  • rapid response team
  • case–control
  • survival

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Health Research Ethics Board, University of Alberta.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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