Abstract 353: Association Between Hospital Resuscitation Team Leader Credentials and Survival Outcomes for In-hospital Cardiac Arrest

Abstract

Background: It is unclear if survival rates for in-hospital cardiac arrest (IHCA) vary across hospitals depending on whether resuscitations are typically led by an attending physician, physician trainee, or a non-physician. We sought to determine the association between resuscitation team leader credentials and IHCA survival. Methods: A nationwide survey was done in 2018 to elicit information on resuscitation practices across hospitals participating in the Get With The Guidelines-Resuscitation registry for IHCA. Using responses from the question of “Who typically leads codes at your institution”, we grouped hospitals based on their typical type of resuscitation team leader: attending physician, physician trainee, or non-physician. Responses from the survey were linked to survival outcomes within the registry. We compared risk-adjusted hospital rates of survival to discharge, return of spontaneous circulation [ROSC] and favorable neurological survival for 2015-2017 between these 3 hospital groups using multi variable hierarchical regression. Results: Overall, 193 hospitals had a minimum of 20 IHCAs and completed the study survey, representing a total of 44,477 IHCAs (mean age of 65.0 ± 15.5, 40.8% were females). Most hospitals had resuscitations led by physicians, with 121 (62.7%) led by an attending physician, 58 (30.0%) by a physician-trainee, and 14 (7.3%) by a non-physician. Risk-standardized rates of survival to discharge were similar across hospitals, regardless of whether resuscitations were typically led by an attending physician, physician trainee, or non-physician (25.6±4.8%, 25.9±4.7%, and 25.7±3.6%, respectively; p = 0.88). Similarly, there were no differences between the 3 groups in risk-adjusted rates of ROSC (71.7±6.3%, 73±6.3%, and 73.4±6.4%; P = 0.30) and favorable neurological survival (21.6±7.1%, 22.7±6.1%, and 20.9±6.5%; P = 0.50; Figure). Conclusion: Among hospitals in a national registry, IHCA resuscitations were usually led by physicians. However, there was no association between a hospital’s typical resuscitation team leader credentials and IHCA survival outcomes.