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

To the Editor: For the study by Chen and colleagues,1 the Journal provided the following taglines: “Early intervention not resuscitation reduces deaths” on the cover of the issue; and “Mortality has decreased due to earlier intervention rather than advances in resuscitation” in the Contents on page 119. These statements contrast with the article's title and contents, which included: “It is an observational study and, as such, we cannot assume any causality for the relationships identified”.1 Does the Journal believe its taglines accurately represented the article?

The largest randomised controlled trial of rapid response teams was the National Health and Medical Research Council-funded MERIT trial,2 which concluded: “The [medical emergency team] system greatly increases emergency team calling, but does not substantially affect the incidence of cardiac arrest, unplanned [intensive care unit] admissions, or unexpected death.” The MERIT trial was undertaken in the same decade and state as the study by Chen et al.1 Should this conflicting data have been discussed in detail?

In the Appendix to their article,1 the authors presented a 19% increase in hospital admissions during the study period. Hospital mortality was expressed as events per 1000 admissions. Was rapid response system implementation associated with decreased total hospital mortality? Could the apparent reduction in hospital mortality be explained by changed patterns of admissions?

The authors wrote: “To our knowledge, there were no other major changes in the way health care was delivered in hospitals over the study period”.1 How did they satisfy themselves that hospital health care had not changed? Did they not think that an increase in hospital admissions of 19% over the decade must imply a major change in hospital health care delivery?