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Cardiopulmonary arrest and mortality trends, and their association with rapid response system expansion

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In reply: Levinson and Mills focus on one of the most important challenges in health care — the appropriate management of patients at the end of life. It is correct to suggest that the rapid response system-associated reduction in inhospital cardiopulmonary arrest may be due to more than just prevention through early intervention, but may also be due to increased attention to end-of-life care and avoidance of inappropriate resuscitation. Up to 30% of all rapid response calls are for patients with end-of-life issues. Perhaps if we develop ways of identifying these patients earlier, a more appropriate management plan could be developed in cooperation with patients and their carers.

O’Callaghan highlights the fact that the MERIT trial provided no evidence of significant improvement of cardiac arrest, unplanned intensive care unit admissions or unexpected death. However, as discussed in our MERIT publication1 in detail and in our Journal article2 to some degree, the MERIT trial was underpowered and the control hospitals acted in a manner similar to that of hospitals with medical emergency team (MET) systems in place (ie, over 35% of cardiac arrest team calls in control hospitals were made for patients without cardiac arrest). Also, the implementation and uptake of MET systems were not optimal (two-thirds of patients did not have a MET call despite meeting…