• Joonas Tirkkonen, Heini Huhtala, and Sanna Hoppu.
• Department of Intensive Care Medicine, Tampere University Hospital and Department of Anaesthesiology and Intensive Care Medicine, Seinäjoki Central Hospital, PO Box 2000, FI-33521 Tampere, Finland. Electronic address: tirkkonen.joonas.o@student.uta.fi.
• Resuscitation. 2018 May 1; 126: 98-103.

AimStudy the incidence and reasons behind in-hospital cardiac arrests (IHCAs) after rapid response team (RRT) reviews.MethodsWe conducted a matched case-control study at Tampere University Hospital, Finland. Data on adult patients who were triaged to remain on general ward after first (index) RRT review without treatment limitations but who suffered an IHCA within the following 48 h were prospectively collected for 5.3 years. These cases were matched (age ±3 years, sex, surgical/medical ward, admission year) at a 1:4 ratio to controls (no ICHA after RRT review).ResultsOf 2653 index RRT reviews, 17 patients suffered an IHCA on general ward within the 48 h after review. Their 30-day mortality rate was 88%. The incidence was 6.3/1000 index RRT reviews or 4.6/100,000 hospital admissions. Patients who suffered an IHCA within 48 h after RRT review were more likely to have a preceding ICU admission, and their median national early warning scores (NEWSs) at the end of the index RRT reviews (=last NEWSs) were higher than those of the controls. Higher last NEWS was the only factor associated with ICHA after RRT review (OR 1.22, 95% CI 1.00-1.49, p = 0.048) in a conditional multivariable regression model.ConclusionsIHCA within 48 h after an index RRT review on general ward is a rare event with poor prognosis. It is independently associated with higher NEWS at the end of the index RRT review. Careful consideration is stressed, when patients with high NEWS are left on ward after RRT reviews.Copyright © 2018 Elsevier B.V. All rights reserved.

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