Cardiac Arrest Deaths Cut 50% by Emergency Team

A study has found that early intervention by a hospital emergency team can slash the number of deaths from unexpected cardiac arrest by 50%. The study was conducted by a team of Australian researchers, led by Michael D. Buist, M.D., director of the intensive care unit (ICU) at Dandenong Hospital (Dandenong, VIC).

The researchers recorded the level of cardiac arrests and the deaths that resulted in a single hospital in a year before (1996) and after (1999) the introduction of a medical emergency team. In 1996, 73 cases of unexpected cardiac arrest occurred, compared with only 47 in 1999. Similarly, death rates were reduced form 77% in 1996 to 55% in 1999, when the emergency team was in place. Overall, the intervention was associated with a 50% reduction in cardiac arrest. The study was reported in the February 16, 2002, issue of the British Medical Journal (BMJ).

The emergency team was proposed as a pre-emptive response system to manage patients with signs of clinical instability, such as deterioration in the airway, circulation, or respiratory system for at least one hour before their index event. When clinical observations reach certain predefined critical limits, the primary care nurse or medical officer calls for the emergency team, which responds immediately. The team comprises a medical registrar, an intensive care registrar, and a senior intensive care nurse. The team is equipped with resuscitational drugs, fluids, and appropriate equipment.

The specific criteria for calling the emergency team were respiratory distress or threatened airway; breathing problems (respiratory rate over 30/min or less than 6/min, SaO2 less than 90% when on oxygen, or difficulty speaking); circulation problems (blood pressure over 90 mm despite treatment or pulse rate over 130/min); and neurologic problems (decrease in consciousness, agitation or delirium, or seizures). Additional criteria included concern about the patient, uncontrolled pain, failure to respond to treatment, and inability to obtain prompt assistance.



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