Changes needed to improve in-hospital cardiac arrest care, survival

Statement Highlights:

  • Improving the readiness of hospitals and healthcare providers to deliver science-based, high quality care can improve survival from in-hospital cardiac arrest.
  • Increasing hospital accountability and reporting and standardizing data collection for in-hospital cardiac arrest will allow institutions’ survival rates and performance to be measured and compared.

Each year, more than 200,000 adults and 6,000 children have in-hospital cardiac arrests, and survival has remained essentially unchanged for decades, statement authors said. According to the American Heart Association, only 24.2 percent of in-hospital cardiac arrest patients survive to hospital discharge.

Much more could be done to improve in-hospital cardiac arrest care by providers, institutions and the healthcare system, authors said.

A big obstacle to better care for in-hospital cardiac arrest is the inability to gather reliable data, said Laurie Morrison, M.D., M.Sc., statement lead author. “We must be able to count how many in-hospital cardiac arrests occur and report comparable outcomes across institutions — and apply the science to everyday care more quickly,” said Morrison, also the Robert and Dorothy Pitts Chair in Acute Care & Emergency Medicine at St. Michael’s Hospital in Toronto.

The statement’s key recommendations include:

  • Establishing competency of all hospital staff in recognizing a cardiac arrest, performing chest compressions and using an automated external defibrillator or AED.
  • Ensuring that best practices are used in all stages of care for cardiac arrest.
  • Requiring that all in-hospital cardiac arrests be reported, with survival data, using consistent definitions across hospitals. Definitions currently are not standardized, researchers said.
  • Mandating that hospitals report rates per 1,000 admissions of do-not-attempt-to-resuscitate orders among patients before an arrest occurs. Variation in reporting and implementing these orders can dramatically skew data about patient outcomes.
  • Modifying billing codes to allow collection of more specific and accurate data for in-hospital cardiac arrest.

The authors also suggest separate guidelines for in-hospital versus out-of-hospital cardiac arrests.

Co-authors are Robert W. Neumar, M.D., Ph.D.; Janice L. Zimmerman, M.D.; Mark S. Link, M.D.; L. Kristin Newby, M.D., M.H.S.; Paul W. McMullan, Jr., M.D.; Terry Vanden Hoek, M.D.; Colleen C. Halverson, R.N., M.S.; Lynn Doering, R.N., D.N.Sc.; Mary Ann Peberdy, M.D. and Dana P. Edelson, M.D., M.S.

Read more about the long term care of sudden cardiac arrest, including the treatment of post-cardiac arrest syndrome. The American Heart Association also has more about how Get With The Guidelines®-Resuscitation is improving hospital care.

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