Critical Care and Shock

The Medical Emergency Team and prevention of sudden cardiac death: where is the data?


Traditionally, cardiopulmonary resuscitation (CPR) has been the main tool for treating victims of cardiac arrest. This therapeutic modality has been known for millennia, and despite its widespread use for the last five decades, it has had only few modifications. The popular belief that CPR is an effective approach for patients with cardiopulmonary arrest has been supported by television medical drama series that always show CPR as a medical icon. (1) However, even when CPR is performed by trained providers, the outcomes remain quite poor, with most patients who require in-hospital CPR dying before hospital discharge, with survival to discharge rates that range from 1 to 20%. (2) With this dismal prognosis, most hospitals have implemented “code teams” that respond to cardiopulmonary arrest scenarios. Less attention has been directed to the events that lead to the cardiopulmonary arrest in the hospital setting. Several retrospective studies have shown that there is a critical period of about 6 to 8 hours before the cardiac arrest occurs, in which the vital signs and other physiological markers start to show deterioration (ie., metabolic, electrocardiographic, respiratory and hemodynamic changes). (3,4)