title: Resuscitation Practices Associated With Survival After In-Hospital Cardiac Arrest: A Nationwide Survey.
abstract: Although survival of patients with in-hospital cardiac arrest varies markedly among hospitals, specific resuscitation practices that distinguish sites with higher cardiac arrest survival rates remain unknown.
  
  
  
  To identify resuscitation practices associated with higher rates of in-hospital cardiac arrest survival.
  
  
  
  Nationwide survey of resuscitation practices at hospitals participating in the Get With the Guidelines-Resuscitation registry and with 20 or more adult in-hospital cardiac arrest cases from January 1, 2012, through December 31, 2013. Data analysis was performed from June 10 to December 22, 2015.
  
  
  
  Risk-standardized survival rates for cardiac arrest were calculated at each hospital and were then used to categorize hospitals into quintiles of performance. The association between resuscitation practices and quintiles of survival was evaluated using hierarchical proportional odds logistic regression models.
  
  
  
  Overall, 150 (78.1%) of 192 eligible hospitals completed the study survey, and 131 facilities with 20 or more adult in-hospital cardiac arrest 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 3 were significant after multivariable adjustment: monitoring for interruptions in chest compressions (adjusted odds ratio [OR] for being in a higher survival quintile category, 2.71; 95% CI, 1.24-5.93; P = .01), reviewing cardiac arrest cases monthly (adjusted OR for being in a higher survival quintile category, 8.55; 95% CI, 1.79-40.00) or quarterly (OR, 6.85; 95% CI, 1.49-31.30; P = .03), and adequate resuscitation training (adjusted OR, 3.23; 95% CI, 1.21-8.33; P = .02).
  
  
  
  Using survey information from acute care hospitals participating in a national quality improvement registry, we identified 3 resuscitation strategies associated with higher hospital rates of survival for patients with in-hospital cardiac arrest. These strategies can form the foundation for best practices for resuscitation care at hospitals given the high incidence and variation in survival for in-hospital cardiac arrest.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri2Department of Medicine, University of Missouri, Kansas City.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: The Veterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan4Department of Internal Medicine, Center for Healthcare Outcomes and Policy, University of Michigan, Ann A.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.affiliation: Department of Medicine, University of Missouri, Kansas City.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: The Veterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan4Department of Internal Medicine, Center for Healthcare Outcomes and Policy, University of Michigan, Ann A.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.affiliation: The Veterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Molly
authors.initials: M
authors.lastname: Harrod
authors.affiliation: Department of Medicine, University of Missouri, Kansas City.
authors.forename: Mary
authors.initials: M
authors.lastname: Kennedy
authors.affiliation: Department of Internal Medicine, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lehrich
authors.affiliation: The Veterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan4Department of Internal Medicine, Center for Healthcare Outcomes and Policy, University of Michigan, Ann A.
authors.forename: Steven
authors.initials: S
authors.lastname: Kronick
authors.affiliation: The Veterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan4Department of Internal Medicine, Center for Healthcare Outcomes and Policy, University of Michigan, Ann A.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends