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

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.