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

• Published in: BMJ Vol. 324; no. 7334; pp. 387 - 390
• Main Authors: Buist, Michael D, Moore, Gaye E, Bernard, Stephen A, Waxman, Bruce P, Anderson, Jeremy N, Nguyen, Tuan V
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 16-02-2002; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ
• Edition: International edition
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac arrest; Death; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency management; Emergency services; Emergency Treatment - methods; Emergency Treatment - standards; Female; Heart Arrest - mortality; Heart Arrest - prevention & control; Heart attacks; Hospital admissions; Hospital Bed Capacity, 300 to 499; Hospital Mortality - trends; Hospitals; Hospitals, Teaching - organization & administration; Humans; Incidence; Intensive care; Intensive care medicine; Intervention; Logistic Models; Male; Medical referrals; Medical sciences; Middle Aged; Mortality; Nurses; Odds Ratio; Patient Care Team - organization & administration; Resuscitation; Risk Factors; Teaching hospitals; Victoria - epidemiology; Victoria; Australia; Human; Prevention; Cardiocirculatory arrest; Emergency department; Q factor; Follow up study; Mortality; Health care staff; Cardiovascular disease; Incidence
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.324.7334.387

AbstractObjectives: To determine whether earlier clinical intervention by a medical emergency team prompted by clinical instability in a patient could reduce the incidence of and mortality from unexpected cardiac arrest in hospital.Design: A non-randomised, population based study before (1996) and after (1999) introduction of the medical emergency team.Setting: 300 bed tertiary referral teaching hospital.Participants: All patients admitted to the hospital in 1996 (n=19 317) and 1999 (n=22 847).Interventions: Medical emergency team (two doctors and one senior intensive care nurse) attended clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response activated by the bedside nurse or doctor according to predefined criteria.Main outcome measures: Incidence and outcome of unexpected cardiac arrest.Results: The incidence of unexpected cardiac arrest was 3.77 per 1000 hospital admissions (73 cases) in 1996 (before intervention) and 2.05 per 1000 admissions (47 cases) in 1999 (after intervention), with mortality being 77% (56 patients) and 55% (26 patients), respectively. After adjustment for case mix the intervention was associated with a 50% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.50, 95% confidence interval 0.35 to 0.73).Conclusions: In clinically unstable inpatients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital.What is already known on this topicIn 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 arrestWhat this paper addsEarly intervention by a medical emergency team significantly reduced the incidence of and mortality from unexpected cardiac arrest in hospital