Abstract 242: Resuscitation Practices Associated with Survival After In-Hospital Cardiac Arrest: A Nationwide Survey

Abstract

Background: Substantial facility-level variation in survival exists following in-hospital cardiac arrest. Yet, specific resuscitation practices that distinguish hospitals with higher cardiac arrest survival remain unknown. Methods: We surveyed hospitals that submitted >20 adult in-hospital cardiac arrest cases to Get With The Guidelines (GWTG)-Resuscitation between 2012 and 2013 about resuscitation practices at their facility. We then used data from GWTG-Resuscitation to calculate risk-standardized rates for survival to discharge for each hospital, and categorized facilities into the top quintile, middle 2 to 4 quintiles, and bottom quintile based on their performance. The association between resuscitation practices and quintiles of survival was evaluated using hierarchical proportional odds logistic regression models. Results: Overall, 150 of 192 active adult hospitals (78.1%) facilities completed the study survey and 131 facilities with >20 cases comprised the final study cohort. Risk-standardized survival rates after in-hospital cardiac arrest varied substantially (median: 23.7%; range: 9.2%-37.5%). Several resuscitation practices were associated with survival on bivariate analysis, although only three were significant after multivariable adjustment: tracking interruptions in chest compressions (adjusted OR for being in a higher survival quintile category, 2.7 [95% CI: 1.2-5.9]; P=0.01); reviewing cardiac arrest cases monthly or quarterly (adjusted OR for being in a higher survival quintile category, 8.6 [1.8-40.0] for monthly and 6.9 [1.5-31.3] for quarterly; P=0.03); and inadequate resuscitation training (adjusted OR for at least a moderate barrier, 0.31 [0.12, 0.83]; P=0.02). Conclusion: Tracking interruptions in chest compressions, frequent review of cardiac arrest cases, and adequate resuscitation training are potentially key resuscitation practices associated with higher in-hospital cardiac arrest survival.

Resuscitation practices in hospitals caring for children: Insights from get with the guidelines-resuscitation

“…At each site, the director of the hospital’s resuscitation committee (e.g., ‘Code Blue’ committee) was asked to provide survey responses. This current survey was developed based on clinical expertise in our team, results from our prior resuscitation survey primarily for adult hospitals in 2014, 3 and outside experts. Resuscitation practices in this survey focused on prevention and treatment of IHCA (e.g., use of simulation training, intra-arrest monitoring devices of CPR quality, post-event debriefing), design and leadership of resuscitation teams, whether nurses are allowed to defibrillate patients before doctors arrive, and resuscitation champion type.…”

“…Recent hospital surveys have described differences in resuscitation response among adult hospitals, 2. , 3. and some studies have identified resuscitation practices associated with higher survival rates for IHCA.…”

“…and some studies have identified resuscitation practices associated with higher survival rates for IHCA. 3. , 4.…”

Survival to intensive care unit discharge among in‐hospital cardiac arrest patients by applying audiovisual feedback device

“…During CPR, chest compression quality is the key for patient survival. 1,2 Various devices have been developed to improve the consistency and quality of chest compressions. [3][4][5][6] Some of these devices are combined with feedback technology to help guide or inform rescuers of CPR.…”

“…Cardiac arrest survival rate is still low despite cardiopulmonary resuscitation (CPR). During CPR, chest compression quality is the key for patient survival 1,2 . Various devices have been developed to improve the consistency and quality of chest compressions 3–6 .…”