• Anna Thorén, Martin Jonsson, Martin Spångfors, Eva Joelsson-Alm, Jan Jakobsson, Araz Rawshani, Thomas Kahan, Johan Engdahl, Arvid Jadenius, Erik Boberg von Platen, Johan Herlitz, and Therese Djärv.
• Department of Medicine Solna, Center for Resuscitation Science, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Physiology, Danderyd University Hospital, SE-182 88 Stockholm, Sweden. Electronic address: anna.thoren@ki.se.
• Resuscitation. 2023 Dec 1; 193: 109978109978.

IntroductionRapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.MethodsA nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.ResultsIn all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90-0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001).ConclusionIHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

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