***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract Objectives : To determine whether earlier clinical intervention by a medical emergency team prompted by clinical instability in a patient could reduce the incidence of and mortality from unexpected cardiac arrest in hospital . Design : A non-r and omised , population based study before ( 1996 ) and after ( 1999 ) introduction of the medical emergency team . Setting : 300 bed tertiary referral teaching hospital . Participants : All patients admitted to the hospital in 1996 ( n=19 317 ) and 1999 ( n=22 847 ) . Interventions : Medical emergency team ( two doctors and one senior intensive care nurse ) attended clinical ly unstable patients immediately with resuscitation drugs , fluid , and equipment . Response activated by the bedside nurse or doctor according to predefined criteria . Main outcome measures : Incidence and outcome of unexpected cardiac arrest . Results : The incidence of unexpected cardiac arrest was 3.77 per 1000 hospital admissions ( 73 cases ) in 1996 ( before intervention ) and 2.05 per 1000 admissions ( 47 cases ) in 1999 ( after intervention ) , with mortality being 77 % ( 56 patients ) and 55 % ( 26 patients ) , respectively . After adjustment for case mix the intervention was associated with a 50 % reduction in the incidence of unexpected cardiac arrest ( odds ratio 0.50 , 95 % confidence interval 0.35 to 0.73 ) . Conclusions : In clinical ly unstable in patients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital . What is already known on this topic In most studies mortality from unexpected cardiac arrest in hospital exceeds 50 % Such events are usually preceded by signs of clinical deterioration in the hours before cardiac arrest What this paper adds Early intervention by a medical emergency team significantly reduced the incidence of and mortality from unexpected cardiac arrest in BACKGROUND Patients with cardiac arrests or who die in general wards have often received delayed or inadequate care . We investigated whether the medical emergency team ( MET ) system could reduce the incidence of cardiac arrests , unplanned admissions to intensive care units ( ICU ) , and deaths . METHODS We r and omised 23 hospitals in Australia to continue functioning as usual ( n=11 ) or to introduce a MET system ( n=12 ) . The primary outcome was the composite of cardiac arrest , unexpected death , or unplanned ICU admission during the 6-month study period after MET activation . Analysis was by intention to treat . FINDINGS Introduction of the MET increased the overall calling incidence for an emergency team ( 3.1 vs 8.7 per 1000 admissions , p=0.0001 ) . The MET was called to 30 % of patients who fulfilled the calling criteria and who were subsequently admitted to the ICU . During the study , we recorded similar incidence of the composite primary outcome in the control and MET hospitals ( 5.86 vs 5.31 per 1000 admissions , p=0.640 ) , as well as of the individual secondary outcomes ( cardiac arrests , 1.64 vs 1.31 , p=0.736 ; unplanned ICU admissions , 4.68 vs 4.19 , p=0.599 ; and unexpected deaths , 1.18 vs 1.06 , p=0.752 ) . A reduction in the rate of cardiac arrests ( p=0.003 ) and unexpected deaths ( p=0.01 ) was seen from baseline to the study period for both groups combined . INTERPRETATION The MET system greatly increases emergency team calling , but does not substantially affect the incidence of cardiac arrest , unplanned ICU admissions , or unexpected death Objective To determine whether the introduction of an intensive care unit-based medical emergency team , responding to hospital-wide preset criteria of physiologic instability , would decrease the rate of predefined adverse outcomes in patients having major surgery . Design Prospect i ve , controlled before- and -after trial . Setting University-affiliated hospital . Patients Consecutive patients admitted to hospital for major surgery during a 4-month control phase and during a 4-month intervention phase . Interventions Introduction of a hospital-wide intensive care unit-based medical emergency team to evaluate and treat in- patients deemed at risk of developing an adverse outcome by nursing , paramedical , and /or medical staff . Measurements and Main Results We measured incidence of serious adverse events , mortality after major surgery , and mean duration of hospital stay . There were 1,369 operations in 1,116 patients during the control period and 1,313 in 1,067 patients during the medical emergency team intervention period . In the control period , there were 336 adverse outcomes in 190 patients ( 301 outcomes /1,000 surgical admissions ) , which decreased to 136 in 105 patients ( 127 outcomes /1,000 surgical admissions ) during the intervention period ( relative risk reduction , 57.8 % ; p < .0001 ) . These changes were due to significant decreases in the number of cases of respiratory failure ( relative risk reduction , 79.1 % ; p < .0001 ) , stroke ( relative risk reduction , 78.2 % ; p = .0026 ) , severe sepsis ( relative risk reduction , 74.3 % ; p = .0044 ) , and acute renal failure requiring renal replacement therapy ( relative risk reduction , 88.5 % ; p < .0001 ) . Emergency intensive care unit admissions were also reduced ( relative risk reduction , 44.4 % ; p = .001 ) . The introduction of the medical emergency team was also associated with a significant decrease in the number of postoperative deaths ( relative risk reduction , 36.6 % ; p = .0178 ) . Duration of hospital stay after major surgery decreased from a mean of 23.8 days to 19.8 days ( p = .0092 ) . Conclusions The introduction of an intensive care unit-based medical emergency team in a teaching hospital was associated with a reduced incidence of postoperative adverse outcomes , postoperative mortality rate , and mean duration of hospital stay A ‘ patient‐at‐risk team ’ , established to allow the early identification of seriously ill patients on hospital wards , made 69 assessment s on 63 patients over 6 months . Predefined physiological criteria were not able to reliably predict which patients would be admitted to the intensive care unit . The incidence of cardiopulmonary resuscitation before intensive care admission was 3.6 % for patients seen by the team and 30.4 % for those not seen ( p < 0.005 ) . Of admissions seen by the team , 25 % died on the intensive care unit compared with 45 % of those not seen ( not significant , p = 0.07 ) . Among those not seen by the team , mortality was 40 % for those who did not require resuscitation and 57 % for those who did ( not significant ) . Many critically ill ward patients had abnormal physiological values before intensive care unit admission . Identification of critically ill patients on the ward and early advice and active management are likely to prevent the need for cardiopulmonary resuscitation and to improve outcome AIM To evaluate the activity and impact of a Medical Emergency Team ( MET ) one year after implementation . SETTING AND POPULATION A 700-bed District General Hospital ( DGH ) in Southeast Engl and with approximately 53,500 adult admissions per annum . The population studied included all adult admissions receiving intervention by the MET during a 12-month period between 1 October 2000 and 30 September 2001 . METHODS Analysis of the activation of the MET using both prospect i ve and retrospectively acquired data . Routinely collected hospital data for admissions , discharges and deaths was used to compare outcomes for the 12 months before and after the introduction of the MET . RESULTS There were 136 activations of MET over 1-year . Six cases were excluded . Mean age of patients was 73 years ( range 20 - 97 years ) . 40 % ( 52/130 ) survived to discharge following MET intervention . Of those who died 22 % ( 28/130 ) were design ated ' not for resuscitation ' . Patients that died were more likely to have three or more physiological abnormalities present ( odds ratio , OR 6.2 , Chi-square ( chi(2 ) ) P = 0.004 ) and had higher MET scores ( P = 0.004 ) . Commonest interventions by the MET were initiation or increase of oxygen therapy  or  ventilatory support  ( 80 % ) , with or without the administration of intravenous fluids or medications . In 10 % of cases , oxygen therapy was the sole intervention . One year after implementation of the MET a reduction in cardiac arrest rate and overall mortality was noted but this was not statistically significant . CONCLUSION Often only simple interventions are only required to reverse deterioration . Initiating ' do not attempt resuscitation ' ( DNAR ) decisions is a key part of MET activity . Multiple physiological abnormalities are associated with increased mortality and therefore wider and earlier application of the MET to the hospital population may save lives or expedite DNAR decisions . New systems need time to develop ( " bed in " ) and further research is needed to observe significant reductions in cardiac arrests and overall mortality Objective To assess the effectiveness of routine intensive care unit surveillance compared with frequent 12-lead electrocardiogram monitoring for detecting electrocardiogram evidence suggestive of prolonged myocardial ischemia in vascular surgery patients . Design Prospect i ve cohort trial . Setting Intensive care unit . Participants We studied 149 patients undergoing elective infrainguinal or aortic vascular surgery who were admitted to the intensive care unit postoperatively . Interventions Patients were simultaneously monitored with a 10-electrode/12-lead electrocardiogram obtained every 2 mins ( criterion st and ard ) and routine intensive care unit surveillance that included st and ard monitoring ( five-electrode/two-lead electrocardiogram with ST segment trends and routine 12-lead electrocardiogram ) and clinical assessment for detecting myocardial ischemia . The results of the criterion st and ard were not available to the caregivers . Measurements and Main Results We measured the ability of routine intensive care unit surveillance to detect the first 20 mins of electrocardiogram evidence suggestive of myocardial ischemia , defined as ST segment depression or elevation of ≥1 mm in two consecutive leads , during the first postoperative day . Seventeen patients ( 11 % ) had electrocardiogram evidence suggestive of prolonged myocardial ischemia , the majority of which occurred in leads V2–V4 . The sensitivity of routine intensive care unit surveillance for detecting the first episode of electrocardiogram evidence suggestive of prolonged myocardial ischemia in a patient was 12 % ( 95 % confidence interval , 7–17 % ) , and the specificity was 98 % ( 95 % confidence interval , 95–100 % ) with a positive predictive value of 40 % ( 95 % confidence interval , 32–48 % ) , a negative predictive value of 90 % ( 95 % confidence interval , 85–94 % ) , a positive likelihood ratio of 6 , and a negative likelihood ratio of 1 . The sensitivity of routine intensive care unit surveillance for detecting all episodes was 3 % ( 95 % confidence interval , 2–3 % ) and the specificity 99 % ( 95 % confidence interval , 99–100 % ) per 20-min monitoring interval , with a positive predictive value of 17 % ( 95 % confidence interval , 16–18 % ) , negative predictive value of 95 % ( 95 % confidence interval , 95–96 % ) , positive likelihood ratio of 3 , and negative likelihood ratio of 1 . Conclusions Routine intensive care unit surveillance has low sensitivity for detecting electrocardiogram evidence suggestive of prolonged myocardial ischemia compared with frequent 12-lead electrocardiograms . Because detecting electrocardiogram evidence suggestive of prolonged postoperative myocardial ischemia is important , physicians should consider alternative strategies to detect myocardial ischemia While the outcome of in-hospital cardiopulmonary arrest  has been studied extensively , the clinical antecedents of arrest are less well defined . We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest .  Prospect ively determined definitions of underlying pathophysiology , severity of underlying disease , patient complaints , and clinical observations were used to determine common clinical features . Sixty-four patients arrested 161 + /- 26 hours following hospital admission . Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients ( 38 percent ) , metabolic in 7 ( 11 percent ) , cardiac in 6 ( 9 percent ) , neurologic in 4 ( 6 percent ) , multiple in 17 ( 27 percent ) , and unclassified in 6 ( 9 percent ) . Patients with multiple disturbances had mainly respiratory ( 39 percent ) and metabolic ( 44 percent ) disorders . Fifty-four patients ( 84 percent ) had documented observations of clinical deterioration or new complaints within eight hours of arrest . Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time . Routine laboratory tests obtained before arrest showed no consistent abnormalities , but vital signs showed a mean respiratory rate of 29 + /- 1 breaths per minute . The prognoses of patients ' underlying diseases were classified as ultimately fatal in 26 ( 41 percent ) , nonfatal in 23 ( 36 percent ) , and rapidly fatal 
    Output:
    
We found weak evidence that rapid response systems are associated with a reduction in hospital mortality and cardiac arrest rates , but limitations in the quality of the original studies , the wide confidence intervals , and the presence of heterogeneity limited our ability to conclude that rapid response systems are effective interventions .