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.