Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98(6):1388-1392.

Patients developing arrest in the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. 

Salamonson Y, Kariyawasam A, van Heere B, O’Connor C. The evolutionary process of Medical Emergency Team (MET) implementation: Reduction in unanticipated ICU transfers. Resuscitation. 2001;49(2):135-141.

The overall number of ICU transfers remained constant. More seriously ill patients were transferred to ICU via the MET system with an accompanying significant fall in unanticipated ICU transfers. The study could not demonstrate whether the observed slight improvement in hospital survival rate over the three years of the study was due to the MET system. 

Saklayen M, Liss H, Markert R. In-hospital cardiopulmonary resuscitation. Survival in one hospital and literature review. Medicine(Baltimore). 1995;74(4):163-175.

This study is a retrospective review of all CPR attempts at the VA Medical Center in Dayton, Ohio, during a two-year period (January 1, 1988, through December 31, 1989).  The authors report that 44 percent of patients survived initial CPR, but only 30 percent were alive 24 hours later and only 13 percent were alive one month later.  Patients with witnessed arrests were more likely to survive initial CPR (57 percent) than patients with unwitnessed arrests (22 percent).

Priestley G, Watson W, Rashidian A, et al. Introducing critical care outreach: A ward-randomised trial of phased introduction in a general hospital. Intensive Care Medicine. 2004;30(7):1398-1404.

This study investigates the effect of a “Critical Care Outreach Team” (analogous to a Medical Emergency Team) on in-hospital mortality and length of stay in an 800-bed general hospital in the north of England.  The authors report a 48 percent reduction in in-hospital mortality.  Findings on length of stay are equivocal.

Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: A report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58(3):297-308.

The three most common reasons for cardiac arrest in adults were cardiac arrhythmia, acute respiratory insufficiency, and hypotension. Forty-four percent of cardiac arrest victims had a return of spontaneous circulation and 17 percent survived to hospital discharge. 

McArthur-Rouse F. Critical care outreach services and early warning scoring systems: A review of the literature. Journal of Advanced Nursing. 2001;36(5):696-704.

Further study is required to evaluate effectiveness and ward staff need to be educated in identifying those patients at risk of developing critical illness. Nurses’ decision making in relation to calling the outreach team requires further investigation. 

Kenward G, Castle N, Hodgetts T, Shaikh L. Evaluation of a medical emergency team one year after implementation. Resuscitation. 2004;61(3):257-263.

Multiple physiological abnormalities are associated with increased mortality. Initiating “do not attempt resuscitation” (DNAR) decisions is a key part of MET activity. A reduction in cardiac arrest rate and overall mortality was noted but was not statistically significant. New systems need time to develop (“bed in”) and further research is needed to observe significant reductions in cardiac arrests and overall mortality.

Kause J, Smith G, Prytherch D, et al. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom – the ACADEMIA study. Resuscitation. 2004;62(3):275-282.

Data obtained from 90 hospitals over a three-day period confirmed that antecedents are common before death, cardiac arrest and unanticipated ICU admission (the most common were hypotension and a fall in Glasgow Coma Scale). Differences in patterns of primary events, provision of ICU/HDU beds, and resuscitation teams between the UK and Australia/New Zealand were noted.

Hodgetts TJ, Kenward G, Vlachonikolis IG, Payne S, Castle N. The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resusitation. 2002;54(2):125-131.

This article describes a study that aimed to: (1) identify risk factors for in-hospital cardiac arrest; (2) formulate activation criteria to alert a clinical response culminating in attendance by a Medical Emergency Team (MET); and (3) evaluate the sensitivity and specificity of the scoring system. A multivariate analysis of cardiac arrest cases identified three positive associations: abnormal breathing, abnormal pulse, and abnormal systolic blood pressure. Risk factors were weighted and tabulated, and formulated into a table of activation criteria for alerting a clinical response. 

Hodgetts TJ, Kenward G, Vlackonikolis I, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54(2):115-123.

Expert panel review of case-notes from 139 consecutive adult in-hospital cardiac arrests over one year. The majority were felt to be potentially avoidable and the panel judged that 100 percent of this majority received inadequate prior treatment.