Background Although many hospitals have resuscitation champions, it is unknown if hospitals with very active physician or nonphysician champions have higher survival rates for in‐hospital cardiac arrest (IHCA). Methods and Results We surveyed adult hospitals in Get With The Guidelines‐Resuscitation about resuscitation practices, including about their resuscitation champion. Hospitals were categorized as having a very active physician champion, a very active nonphysician champion, or other (no champion or not very active champion). For each hospital, we calculated risk‐standardized survival rates for IHCA during the period of 2016 to 2018 and categorized them into quintiles of risk‐standardized survival rates. The association between a hospital's resuscitation champion type and their quintile of survival was evaluated using multivariable hierarchical proportional odds logistic regression. Overall, 192 hospitals (total of 44 477 IHCAs) comprised the study cohort. Risk‐standardized survival rates for IHCA varied widely between hospitals (median: 24.7%; range: 9.2%–37.5%). Very active physician champions were present in 29 (15.1%) hospitals, 64 (33.3%) had very active nonphysician champions, and 99 (51.6%) did not have a very active champion. Compared with sites without a very active resuscitation champion, hospitals with a very active physician champion were 4 times more likely to be in a higher survival quintile, even after adjusting for resuscitation practices across hospital groups (adjusted odds ratio [OR], 3.90; 95% CI, 1.39–10.95). In contrast, there was no difference in survival between sites without very active champions and those with very active non‐physician champions (adjusted OR, 1.28; 95% CI, 0.62–2.65). Conclusions The background and engagement level of a resuscitation champion is a critical factor in a hospital's survival outcomes for IHCA.
Background: Hospitals vary markedly in survival rates for their patients with in-hospital cardiac arrest (IHCA). Although many sites have resuscitation champions, whether a resuscitation champion’s clinical background and intensity of engagement distinguishes sites with higher cardiac arrest survival rates remains unknown. Methods: We conducted a nationwide survey of adult hospitals participating in GWTG-Resuscitation to elicit detailed information on resuscitation practices, including of their resuscitation champion. Risk-standardized survival rates for IHCA for 2016-2017 were calculated for each hospital, and these were then used to categorize hospitals into quintiles of performance. The association between a resuscitation champion’s clinical background and intensity of engagement (categorized as very active non-physician champion, very active physician champion, and all others) and quintiles of survival was evaluated using multivariable hierarchical proportional odds logistic regression models. Results: Overall, 200 of 218 eligible adult hospitals (91.7%) completed the study survey and 190 facilities with > 10 cases comprised the final study cohort. Risk-standardized survival rates after IHCA varied substantially (median: 24.7%; range: 9.2% to 37.5%). One-third (63/190 [33.2%]) of hospitals had a very active non-physician champion, 29 (15.3%) had a very active physician champion, and the remaining 98 (51.2%) had a resuscitation champion not perceived to be very active or had no champion. Compared to sites with very active non-physician champions, those with a very active physician champion had 5-fold higher odds (adjusted OR, 5.15 [95% CI: 2.13-12.5]) of being in a higher survival quintile category, whereas there was no difference in survival outcomes between sites with less active or no resuscitation champions and very active non-physician champions (adjusted OR, 0.94 [95% CI: 0.52-1.77]) . Conclusions: Although most hospitals have resuscitation champions, the background and engagement level of a resuscitation champion is a critical factor in a hospital’s survival outcomes for IHCA. Hospitals with the highest survival rates for IHCA are more likely to have very active physician resuscitation champions.
Background: Resuscitation practices for adult in-hospital cardiac arrest (IHCA) vary widely, based on setting and size. Resuscitation practices in pediatric hospitals have not been examined in detail, and whether practices differ between free-standing pediatric hospitals and combined hospitals (which care for adults and children) is unknown. Methods: We conducted a survey of U.S. hospitals that submit data on pediatric IHCA to GWTG-Resuscitation, a large national registry of IHCA, to elicit detailed information on resuscitation practices. Hospitals were categorized as free-standing pediatric hospitals and combined hospitals, and rates of resuscitation practices were compared. Results: A total of 33 hospitals with at least 5 IHCA events between 2015-2019 completed the survey, of which 9 (27.3%) were freestanding pediatric hospitals and 24 (72.7%) were combined hospitals. Overall, 18 (54.5%) hospitals used a device to measure chest compression quality, 2 (6.1%) used a mechanical device to deliver chest compressions, 6 (18.2%) routinely monitored diastolic pressures during resuscitations, 16 (48.5%) had a staff member monitor chest compression quality, 10 (30.3%) used lanyards or hats to designate leaders during a resuscitation, 16 (48.5%) routinely conducted immediate code debriefings, and 7 (21.2%) conducted mock codes at least quarterly and 17 (51.5%) reported no set schedule. Freestanding pediatric hospitals were more likely to employ a device to measure chest compressions (88.9% vs. 41.7%; P=0.016), conduct code debriefing always or frequently after resuscitations (77.8% vs. 37.5%, P=0.044), use lanyards or a hat to designate the code team leader during resuscitations (66.7% vs. 16.7%, P=0.006), and allow nurses to defibrillate using an AED (77.8% vs. 29.2%, P=0.01). There were no differences in simulation frequency or other resuscitation practices between the 2 hospital groups. Conclusions: Across hospitals caring for pediatric patients, substantial variation exists in resuscitation practices. For some resuscitation practices, there were differences between freestanding pediatric hospitals and hospitals which care for both adults and children.
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