Survival After In-Hospital Cardiac Arrest and Return of Spontaneous Circulation: An Exploration of Outcome Variation...

In-hospital cardiac arrest (IHCA) survival has improved over the past 2 decades due to better acute resuscitation survival, but postresuscitation survival, a key to the IHCA chain of survival, has remained stagnant over time.

We performed a cohort study linking the American Heart Association GWTG-R (Get With The Guidelines-Resuscitation) registry to the American Hospital Association survey, including adult patients with IHCA with sustained return of spontaneous circulation from 2001 to 2024. Postresuscitation risk-standardized survival rates were calculated using predicted (hospital-specific) to expected (population-averaged) survival, reflecting whether post-return of spontaneous circulation survival at a given hospital was better or worse than expected for an average hospital. Social Deprivation Index was assigned via ZIP-to-ZIP Code Tabulation Area linkage and analyzed by quartile.

Of 686 273 IHCAs, 206467 from 755 hospitals were included. Overall, 71 691 (34.7%) survived to discharge. The median risk-standardized survival rate was 33.9% (interquartile range, 32.6%-35.1%). The risk-standardized survival rate varied substantially across hospitals (25.0% to 44.8%). Five hundred ninety-five (78.8%) hospitals were linked to the Social Deprivation Index by ZIP code. Patients from hospitals in the lowest Social Deprivation Index quartile (least deprivation) had a higher postresuscitation risk-standardized survival rate than those in the highest quartile (adjusted odds ratio, 1.13 [95% CI, 1.03-1.23]; P<0.01); the relationship across quartiles was not monotonic. Hospitals in higher Social Deprivation Index quartiles (more deprivation) had higher proportions of early postresuscitation fever and death.

Substantial hospital-to-hospital variation exists in postresuscitation survival, and greater hospital-based community social deprivation is associated with worse postresuscitation outcomes at the patient level. These results identify the postresuscitation phase of care as a promising area for future quality improvement and research efforts to improve outcomes after IHCA.