Hospital cardiac arrest resuscitation practice in the United States: a nationally representative survey

Abstract

Background: In-hospital cardiac arrest (IHCA) outcomes vary widely between hospitals, even after adjusting for patient characteristics, suggesting variations in practice as a potential etiology. However, little is known about the standards of IHCA resuscitation practice among US hospitals.

Objective: To describe current US hospital practices with regard to resuscitation care.

Design: A nationally representative mail survey.

Setting: A random sample of 1000 hospitals from the American Hospital Association database, stratified into 9 categories by hospital volume tertile and teaching status (major teaching, minor teaching, and nonteaching).

Subjects: Surveys were addressed to each hospital's cardiopulmonary resuscitation (CPR) committee chair or chief medical/quality officer.

Measurements: A 27-item questionnaire.

Results: Responses were received from 439 hospitals with a similar distribution of admission volume and teaching status as the sample population (P = 0.50). Of the 270 (66%) hospitals with a CPR committee, 23 (10%) were chaired by a hospitalist. High frequency practices included having a rapid response team (91%) and standardizing defibrillators (88%). Low frequency practices included therapeutic hypothermia and use of CPR assist technology. Other practices such as debriefing (34%) and simulation training (62%) were more variable and correlated with the presence of a CPR committee and/or dedicated personnel for resuscitation quality improvement. The majority of hospitals (79%) reported at least 1 barrier to quality improvement, of which the lack of a resuscitation champion and inadequate training were the most common.

Conclusions: There is wide variability among hospitals and within practices for resuscitation care in the United States with opportunities for improvement.

Figure 1. Hospital responders to in-hospital resuscitations by institution type and level of participation

Bars represent the percent of hospitals reporting usual resuscitation responders in their hospitals, stratified by the teaching status of the hospital. Each bar is further subdivided by the likelihood of that provider to lead the resuscitation.

Figure 2. Barriers to resuscitation quality improvement by institution type

Bars represent the percent of responders reporting specific perceived barriers to resuscitation quality improvement at their hospital, stratified by the teaching status of the hospital.