Resuscitation Quality Improvement Program for CPR Training and Cardiac Arrest Survival in Hospitals

Since 2018, the Resuscitation Quality Improvement (RQI) program to enhance cardiopulmonary resuscitation (CPR) training and skill retention has expanded to many US hospitals.

To evaluate whether adoption of the RQI program is associated with higher in-hospital cardiac arrest (IHCA) survival, compared with control (non-RQI) hospitals.

This cohort study included 237 US hospitals participating in Get With The Guidelines-Resuscitation registry between 2017 and 2023. Control hospitals were uniquely matched to an RQI hospital if they had a 2-year risk-standardized survival rate (RSSR) to discharge for IHCA that was within 1% of the RQI hospital's RSSR during the 2-year preintervention period before RQI adoption, and if both had annual IHCA case volume within 50 cases of each other. Hierarchical models were used to conduct a difference-in-differences analysis to compare the 2-year postintervention vs 2-year preintervention IHCA survival rates at RQI vs control hospitals. Analyses were conducted from December 12, 2024, to October 6, 2025.

Hospital adoption of RQI program.

RSSR to hospital discharge and return of spontaneous circulation (ROSC).

Of 237 hospitals, 107 control hospitals were matched to 18 RQI hospitals (5 adopted RQI in 2019, 8 in 2020, and 5 in 2021), constituting a total of 49 870 IHCAs. Mean (SD) RSSR to hospital discharge at RQI hospitals decreased from 25.3% (3.5%) in the preintervention period to 21.2% (3.8%) in the postintervention period, whereas mean (SD) RSSR at control hospitals decreased from 25.0% (2.9%) to 21.5% (4.4%). When postintervention vs preintervention survival rates were compared between the groups, RQI adoption was not associated with improvements in survival to discharge (difference-in-differences adjusted odds ratio [OR], 0.95 [95% CI, 0.81-1.10]; P = .48). For ROSC, mean (SD) RSSR at RQI hospitals decreased from 73.4% (5.7%) in the preintervention period to 69.1% (5.1%) in the postintervention period, whereas it decreased from 70.9% (6.9%) to 69.1% (7.5%) at control hospitals. When postintervention vs preintervention ROSC rates were compared, RQI adoption was not associated with higher rates of ROSC (difference-in-differences adjusted OR, 0.98 [95% CI, 0.81-1.18]; P = .85).

In this cohort study using a national registry of IHCA data, compared with control hospitals, hospital adoption of the RQI program was not associated with improved rates of survival to discharge or ROSC in the 2 years after implementation. These findings suggest that a program focused solely on CPR delivery may not be sufficient to improve IHCA survival.