Sudden death among hospitalized patients, most often manifesting as in-hospital cardiac arrest, is a global problem that poses major challenges for prediction, timely diagnosis, and expeditious treatment. Incidence and outcomes vary considerably across health systems but remain sobering. Hospitalized patients with acute illness are vulnerable to intercurrent events that can precipitate rapid deterioration. Caring for these patients requires advanced competencies, such as airway management, treatment of arrhythmias, and hemodynamic support, all of which are challenging to acquire and maintain across all medical professionals on general wards. This is why rapid response teams have been utilized as a system-level strategy to recognize early deterioration of patients and bring concentrated expertise to the bedside.

In this issue of the International Journal of Cardiovascular Sciences, Salvadori et al. report a prospective, single-center, five-year evaluation of a rapid response team program in a quaternary Brazilian hospital. Over the study period, the team attended 4,805 emergencies, consisting of 551 cardiac arrests and 4,254 non-arrest deteriorations. Survival among patients with non-arrest emergencies improved significantly (from 57.1% to 64.5%; p = 0.003), whereas survival after cardiac arrest remained low and unchanged. The study has several strengths: it is a large, real-world, prospective analysis that captures process-of-care metrics beyond outcomes, such as time to epinephrine, time to first shock, and time to advanced airway. This level of granularity in the data is crucial in the care of critically ill patients. Outcomes may be unfavorable despite coordinated, appropriate care because of underlying severity, and conversely, occasional survival may occur despite suboptimal response. Measuring processes in detail allows teams to distinguish signal from noise and thereby improve performance over time.

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