In-Hospital Cardiac Resuscitation During Widespread Resident Resignations in South Korea

Health care crises may be associated with changes in in-hospital cardiac arrest (IHCA) care and resuscitation practices. Whether prolonged health care workforce shortage is associated with termination of resuscitation (TOR) practices remains unclear.

To determine whether a nationwide resident resignation in South Korea was associated with differences in IHCA characteristics, resuscitation trajectories, and TOR practices.

A retrospective cohort study conducted at a single tertiary teaching hospital in South Korea of adults aged 18 years or older who underwent cardiopulmonary resuscitation (CPR) for IHCA between March 1, 2023, and February 28, 2025.

IHCA occurring before vs during a workforce crisis precipitated by mass resident physician resignations.

Primary outcomes were return of spontaneous circulation (ROSC) and TOR without ROSC, analyzed as competing events over CPR duration. Secondary outcomes included CPR duration, 24-hour survival, 30-day survival, favorable neurological status, and survival to discharge.

A total of 383 patients with 469 IHCA events were included (median [IQR] age, 69 [61-79] years; 238 [62.1%] male). Overall IHCA incidence did not differ between periods (2.30 vs 2.50 incidents per 1000 admissions; P = .36). The median CPR duration was 8 minutes in both periods. CPR exceeding 35 minutes was less frequent during vs before the crisis (12 of 180 events [6.7%] vs 38 of 289 events [13.1%]; P = .03). ROSC, neurological outcomes, and survival outcomes did not differ statistically. In adjusted competing-risk analyses, the crisis period was not associated with ROSC (adjusted hazard ratio [aHR], 0.93; 95% CI, 0.72-1.19) but was associated with higher hazard of TOR without ROSC (aHR, 1.66; 95% CI, 1.14-2.42). Standardized cumulative incidence analyses showed a higher cumulative incidence of TOR without ROSC, with an absolute risk difference of 4.9 percentage points at 35 minutes.

In this retrospective cohort study, the crisis period was associated with fewer prolonged CPR attempts, with no significant differences in ROSC or survival outcomes. These findings suggest that prolonged health care workforce shortage and associated resuscitation-system adaptations may have influenced TOR practices, underscoring the need for standardized TOR decision-making.