A44-48 Beyond the First 48 Hours: Outcomes After Medical Emergency Team Activation for Respiratory Distress Without Early Escalation

Abstract INTRODUCTION Medical Emergency Teams (METs) stabilize deteriorating ward patients. While early outcomes of MET encounters and the elevated risk faced by these patients are well described, little is known about what happens beyond the initial event. Patients not transferred to intensive care units (ICU) or placed on advanced respiratory support within 48 hours are often presumed clinically stable, yet their subsequent outcomes remain underexplored. We examined late deterioration, mortality, and the role of goals-of-care transitions in this cohort. Methods We retrospectively analyzed a prospectively maintained MET database at a 510-bed tertiary hospital in Jeddah, Saudi Arabia (January 2021-December 2023). Each MET comprised a resident physician, ICU nurse, and respiratory therapist, with pharmacist support as needed. Of 549 MET activations for respiratory distress, we excluded patients who were transferred to the ICU within 48 hours of the index event or were initiated on noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC). The remaining 118 patients constituted the study cohort. Variables included demographics, comorbidities, acute illness severity, and MET characteristics. The primary outcome was in-hospital mortality; secondary outcomes included late ICU transfer (48 h), intubation, and hospital length of stay. Results A total of 118 patients met study criteria. The cohort had a mean age of 58 years with high comorbidity (Charlson Comorbidity Index 5.5; APACHE II 14.5); nearly half had a hospice-eligible illness, and half had cancer, reflecting a complex referral population. At MET activation, mean oxygen saturation was 88% and the initial applied FiO2 was 0.46. The respiratory rate improved from 27 to 23 breaths/min by the end of the call. Forty percent were reviewed by the ICU team and deemed suitable for ward care. Despite apparent stability, outcomes were poor. Twenty-one individuals (18%) required ICU transfer after 48 hours (median 7 days); 13 were intubated, and 8 died in ICU. Overall, 30 patients (25%) died in hospital, including 22 ward deaths following transition to do-not-attempt-resuscitation (DNAR) or comfort-measures-only orders. Median hospital length of stay was 20 days. CONCLUSION One in four ward patients deemed initially stable after MET activation for respiratory distress died during the same hospitalization, most after late ICU transfer or DNAR/comfort-care transition. Beyond the first 48 hours, apparent stability often masked poor longer-term outcomes, underscoring the need to leverage MET encounters for prognostic reassessment and early goals-of-care discussions. This abstract is funded by: None