Adult Patient Outcomes in Rapid Response Activations for Acute Hemorrhage

Introduction: Acute hemorrhage is a common indication for rapid response team (RRT) activation in the adult patient population outside of the intensive care unit (ICU). The purpose of this investigation was to study the clinical trajectory, morbidity, and mortality outcomes of patients at a large academic medical center in the Southeastern United States who received a RRT activation due acute hemorrhage.


Methods: RRT activations for acute hemorrhage over a two year period (June 01, 2023-June 30, 2025) were reviewed to identify 1) if patients demonstrated a clear source of bleeding as evidenced by computed tomography angiography, ultrasound, and/or endoscopy findings; 2) objective indications of hemorrhage including reduction in hemoglobin >= 3 g/dL 12 hours prior to RRT activation, heart rate >= 110 beats/minute, and/or systolic blood pressure <= 90mmHg; 3) the etiology of hemorrhage; 4) the number of packed red blood cell (PRBC) units transfused during resuscitation; 5) patient disposition following RRT activation; 6) hospital mortality rate; and 7) ICU and hospital length of stay (LOS) for patients surviving to discharge.


Results: During the investigation period, we identified 98 patients with a clear source of hemorrhage during RRT activation. Of those, 58 patients also demonstrated at least one additional indication of acute hemorrhage. The etiology of bleeding was identified as post-operative/post-procedural in 22 (37.9%) patients and spontaneous or coagulopathic bleeding in 36 (62.1%) patients. Patients received an average of 2.55 units of PRBC. Following RRT activation, 13 (22.4%) patients remained in their current location, 3 (5.1%) were elevated to a stepdown floor, 34 (58.6%) were transferred to an ICU, and 8 (13.8%) were transferred directly to a procedural suite. The in-hospital mortality of this cohort was 25.9% (n=15). In patients surviving to discharge, the average ICU LOS was 3.6 days, and the average hospital LOS was 22.8 days.


Conclusions: Acute clinical deterioration due to hemorrhage in non-ICU settings was associated with a high transfer rate to an ICU setting or procedural area, prolonged hospital LOS, and expectedly elevated mortality rates. Further studies are warranted to elucidate outcomes in patients developing acute hemorrhage necessitating RRT activation outside of the ICU.