Three resuscitation strategies may increase survival after in-hospital cardiac arrest
Researchers have identified three resuscitation strategies associated with higher rates of survival for patients with in-hospital cardiac arrest, according to a study published in the Journal of the American Medical Association Cardiology.
Paul S. Chan, MD, MSc , of Saint Luke’s Mid America Heart Institute in Kansas City, and colleagues surveyed resuscitation practices at 192 U.S. hospitals and analyzed data from 17,613 adult patients enrolled in the American Heart Association’s Get With the Guidelines-Resuscitation registry. Pediatric patients were excluded from this study. The final cohort comprised 131 hospitals that completed the study survey and had at least 20 in-hospital cardiac arrest cases.
The risk-standardized survival rates for in-hospital cardiac arrest varied among hospitals, from 9.2% to 37.5%. The median risk-standardized survival rate for hospitals in the top quintile of performance was 30.9% compared with 23.6% for hospitals in the middle three quintiles of performance and 19% for hospitals in the bottom quintile of performance.
Three resuscitation practices were significantly associated with survival after multivariable adjustment. Hospitals that tracked interruptions in chest compressions had double the odds of being in a higher survival quintile compared with hospitals that did not track interruptions (adjusted OR = 2.71; 95% CI, 1.24-5.93). Hospitals that reviewed cardiac arrest cases on a monthly basis (adjusted OR = 8.66; 95% CI, 1.79-40) or quarterly basis (adjusted OR = 6.85; 95% CI,1.49-31.3) had six-times-greater the odds of being in a higher survival quintile than those that did not review cases. Adequate resuscitation training also increased the odds of being in a higher survival quintile (OR = 3.23; 95% CI, 1.21-8.33), according to the results.
The risk-standardized survival rate was 21.3% among hospitals that implemented at least one of these three resuscitation strategies compared with 24.3% among hospitals that implemented two of the strategies. The survival rate at hospitals that utilized all three resuscitation strategies was 25.8%.
“Although three hospital strategies were identified, further prospective studies are needed to demonstrate that their dissemination is associated with improved hospital survival, especially in hospitals in the lower quintiles,” Chan and colleagues wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.