Redefining in-hospital resuscitation: the concept of the medical emergency team.

Cardiopulmonary resuscitation (CPR) has evolved over centuries with the greatest progress being made in the last 4 decades [1]. In 1958 and 1960 key advances were described by Safar [2] and Kouwenhoven [3] which have now become the basis for modern day basic life support (BLS) CPR. Extending BLS, advanced life support (ALS) guidelines have been developed to deal with the complex scenarios that result in and accompany cardiac arrest situations [4–6]. Cardiopulmonary resuscitation (CPR) is accepted practice for sudden in-hospital and out of hospital death. Cardiopulmonary resuscitation has become something of an industry. There are international organisations and conferences on resuscitation, numerous textbooks are written on the subject and journals, such as Resuscitation, are dedicated to improving resuscitation outcomes. Resuscitation features increasingly in the lay media. Television medical dramas commonly feature CPR. Interestingly, the results of television CPR are usually shown as successful and unrealistic in the US while in the UK the TV outcome is more likely to be bad and realistic [7,8]. The general public perception of outcome following CPR is overoptimistic while unfortunately CPR is usually a perimortem event. A recent review stated that CPR will be futile in some victims of cardiac arrest [9]. In fact, the majority of patients requiring in-hospital CPR die before hospital discharge. Survival to discharge rates after in-hospital CPR vary from 1 to 2% [10] to around 14% [11,12]. Other studies indicate survival figures between these figures [13–19]. It is interesting to note that there has not been a demonstrated improvement in general mortality rates after in-hospital CPR over the last 30 years. This is in spite of the enormous resources devoted to CPR in terms of education, research and the clinician’s time as well as refinements and developments related to CPR. Cardiopulmonary resuscitation has become something of a medical icon. Most are enthusiastic about its use in spite of the poor outcomes, few have urged restraint [20–22]. Increasingly there * Corresponding author. Present address: Division of Critical Care, The Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.