Letters

Medical emergency teams and cardiac arrests in hospital

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7347.1215/a (Published 18 May 2002) Cite this as: BMJ 2002;324:1215

Results may have been due to education of ward staff

  1. Gary B Smith (gary.smith@porthosp.nhs.uk), consultant in intensive care medicine,
  2. Jerry Nolan, consultant in anaesthesia and intensive care
  1. Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY
  2. Royal United Hospital, Bath BA1 3NG
  3. Southampton University Hospitals Trust, Mailpoint 816, Southampton SO16 6YD
  4. Departments of Surgery and Intensive Care, Dandenong Hospital, Dandenong, Victoria 3175, Australia
  5. Garvan Institute of Medical Research, Darlinghurst, New South Wales 2010, Australia
  6. Monash Institute of Public Health, Clayton, Victoria 3168

    EDITOR—Proof that a medical emergency team can reduce the incidence of and mortality from unexpected cardiac arrest is eagerly awaited, as such a proposal is intuitive. However, the number of such arrests can be influenced by several factors, including the number of “do not resuscitate” decisions made. Buist et al's paper fails to take this into account, and suffers from other methodological errors too.1

    The study used a historical control group and was undertaken in a setting in which there was already a trend towards a reduced incidence of and mortality from cardiac arrest. Moreover, the case mix varied considerably between the two study periods. The authors' definition of cardiac arrest included patients who had not actually experienced an arrest yet excluded four who had been allocated do not resuscitate orders but for whom a call was made. Ward patients who do not have a cardiac arrest have a better outcome than those who do; hence by adopting a loose definition the study denominator has been artificially enhanced, giving a false benefit.

    Some patients receive cardiopulmonary resuscitation despite it being futile, and thus the resuscitation status of critically ill patients must be established. However, any increase in do not resuscitate orders inevitably reduces the incidence of and mortality from unexpected cardiac arrests. The introduction of a medical emergency team increases the number of …

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