Identifying Acute Cardiac Deterioration in a Critical Care Setting and Establishing a New Recognition Protocol

Background: The early detection of clinical signs indicating cardiac deterioration can reduce the risk of adverse outcomes (Jones et al., 2013). Worsening physiological symptoms can easily go overlooked or unmanaged, if professionals are not educated properly. When these symptoms are not addressed, patients can experience treatment delays and mortality (Preece et al., 2012). The early detection of cardiac deterioration’s clinical signs can reduce the risk worsening condition, or death. Defining a unit protocol for nurses would allow a systematic way to evaluate patients and their health status.

Objectives: The purpose of an integrative literature review was to identify signs and symptoms that precede acute cardiac deterioration within a critical care setting, and to establish a new recognition protocol to ameliorate patient care outcomes. Cardiac deterioration is a major public health problem with over 350,000 in-hospital cardiac arrests happening each year in the United States (American Heart Association, 2016). Nurses need to be better educated on the signs and symptoms that antecede a cardiac arrest, and have a protocol to identify and to initiate intervention.

Method: An integrative literature review was conducted undergoing an extensive integrative search to identify acute cardiac deterioration within a critical care setting and recognizing protocol measures. Whittemore and Knafl’s (2005) approach to amalgamate review writing was used as a framework to synthesize and organize the literature found.

Results: Vital signs, level of consciousness, lab values, EKG, and age were found to be the most supported symptoms, which lead to acute cardiac deterioration within a critical care setting (Soar & Subbe, 2012; Hodgetts, et al, 2006; Preece et al., 2012). It is unknown if the the current protocols for nurses to recognize these signs are effective in treating patients. Recommendations for a new protocol include the development of an early warning score system.

Conclusions: This review found five clinical symptoms related to cardiac deterioration; however, these symptoms in current nursing protocol programs are not well addressed. Thus, there is a need to develop an appropriate prevention program incorporating these symptoms to help decrease the risk for cardiac deterioration with the intensive care unit.