Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study

doi:10.1136/bmj.324.7334.387

BMJ 2002;324:387-390 ( 16 February )

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Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study

Michael D Buist, director of intensive care unit, ^a Gaye E Moore, research nurse, ^a Stephen A Bernard, deputy director of intensive care unit, ^a Bruce P Waxman, surgical programme director, ^a Jeremy N Anderson, associate professor, ^b Tuan V Nguyen, senior fellow. ^c

^a Departments of Intensive Care and Surgery, Dandenong Hospital, Dandenong, VIC 3175, Australia, ^b Monash University Institute of Public Health,, ^c University of New South Wales Department of Anaesthetics, Emergency Medicine and Critical Care,

Correspondence to: M Buist acmdbuist{at}bigpond.com

Objectives: To determine whether earlier clinical interventionby a medical emergency team prompted by clinical instability ina patient could reduce the incidence of and mortality from unexpectedcardiac arrest inhospital.
Design: A non-randomised, population based study before(1996) and after (1999) introduction of the medical emergencyteam.
Setting: 300 bed tertiary referral teachinghospital.
Participants: All patients admitted to the hospital in 1996(n=19 317) and 1999 (n=22847).
Interventions: Medical emergency team (two doctors and onesenior intensive care nurse) attended clinically unstable patientsimmediately with resuscitation drugs, fluid, and equipment. Responseactivated by the bedside nurse or doctor according to predefinedcriteria.
Main outcome measures: Incidence and outcome of unexpected cardiacarrest.
Results: The incidence of unexpected cardiac arrestwas 3.77 per 1000 hospital admissions (73 cases) in 1996 (beforeintervention) and 2.05 per 1000 admissions (47 cases) in 1999(after intervention), with mortality being 77% (56 patients) and55% (26 patients), respectively. After adjustment for case mixthe intervention was associated with a 50% reduction in the incidenceof unexpected cardiac arrest (odds ratio 0.50, 95% confidenceinterval 0.35 to 0.73).
Conclusions: In clinically unstable inpatients early interventionby a medical emergency team significantly reduces the incidenceof and mortality from unexpected cardiac arrest inhospital.

What is already known on this topic
In most studies mortality from unexpected cardiac arrest in hospital exceeds 50%

Such events are usually preceded by signs of clinical deterioration in the hours before cardiac arrest

What this paper adds
Early intervention by a medical emergency team significantly reduced the incidence of and mortality from unexpected cardiac arrest in hospital

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Rapid Responses:

Read all Rapid Responses

CPR team work has positive effect on success: Manzar Hosein Akbar, et al.
bmj.com, 16 Feb 2002 [Full text]
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Cover picture is a fake: Arthur Hollman
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The cover photograph: Michelle E Tempest, et al.
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