A prospective before-and-after trial of a medical emergency team

Rinaldo Bellomo, Donna Goldsmith, Shigehiko Uchino, Jonathan Buckmaster, Graeme K Hart, Helen Opdam, William Silvester, Laurie Doolan, Geoffrey Gutteridge
Medical Journal of Australia 2003 September 15, 179 (6): 283-7

OBJECTIVE: To determine the effect on cardiac arrests and overall hospital mortality of an intensive care-based medical emergency team.

DESIGN AND SETTING: Prospective before-and-after trial in a tertiary referral hospital.

PATIENTS: Consecutive patients admitted to hospital during a 4-month "before" period (May-August 1999) (n = 21 090) and a 4-month intervention period (November 2000 -February 2001) (n = 20 921).

MAIN OUTCOME MEASURES: Number of cardiac arrests, number of patients dying after cardiac arrest, number of postcardiac-arrest bed-days and overall number of in-hospital deaths.

RESULTS: There were 63 cardiac arrests in the "before" period and 22 in the intervention period (relative risk reduction, RRR: 65%; P < 0.001). Thirty-seven deaths were attributed to cardiac arrests in the "before" period and 16 in the intervention period (RRR: 56%; P = 0.005). Survivors of cardiac arrest in the "before" period required 163 ICU bed-days versus 33 in the intervention period (RRR: 80%; P < 0.001), and 1353 hospital bed-days versus 159 in the intervention period (RRR: 88%; P < 0.001). There were 302 deaths in the "before" period and 222 in the intervention period (RRR: 26%; P = 0.004).

CONCLUSIONS: The incidence of in-hospital cardiac arrest and death following cardiac arrest, bed occupancy related to cardiac arrest, and overall in-hospital mortality decreased after introducing an intensive care-based medical emergency team.

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