• Joonas Tirkkonen, Markus B Skrifvars, Michael Parr, Tero Tamminen, and Anders Aneman.
• Department of Intensive Care Medicine and Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland. PO Box 2000, FI-33521 Tampere, Finland; Intensive Care Unit, Liverpool Hospital, Sydney, Australia. Cnr Elizabeth and Goulburn Sts, Liverpool, NSW 2170, Australia. Electronic address: joonas.tirkkonen@tuni.fi.
• Resuscitation. 2020 Apr 1; 149: 109-116.

AimTo investigate in-hospital cardiac arrests (IHCAs) according to the Ustein template in hospitals with mature systems utilizing rapid response teams (RRTs), with a special reference to preceding RRT factors and factors associated with a favourable neurological outcome (cerebral performance category (CPC) 1-2) at hospital discharge.MethodsMulticentre, retrospective cohort study between 2017-2018 including two Finnish and one Australian university affiliated tertiary hospitals.ResultsA total 309 IHCAs occurred with an incidence of 0.78 arrests per 1000 hospital admissions. The median age of the patients was 72 years, 63% were male and 73% had previously lived a fully independent life with a median Charlson comorbidity index of two. Before the IHCA, 16% of the patients had been reviewed by RRTs and 26% of the patients fulfilled RRT activation criteria in the preceding 8 h of the IHCA. Return of spontaneous circulation was achieved in 53% of the patients and 28% were discharged from hospital with CPC 1-2. In a multivariable model, younger age, no pre-arrest RRT criteria, arrest in normal work hours, witnessed arrest and shockable initial rhythm were independently associated with CPC 1-2 at hospital discharge.ConclusionsIn hospitals with mature rapid response systems most IHCA patients live a fully independent life with low burden of comorbid diseases before their hospital admission, the IHCA incidence is low and outcome better than traditionally believed. Deterioration before IHCA is present in a significant number of patients and improved monitoring and earlier interventions may further improve outcomes.Copyright © 2020 Elsevier B.V. All rights reserved.

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