Background In-hospital cardiac arrest (IHCA) survival has improved over the past two decades, resulting from better acute resuscitation survival. Post-resuscitation care is a key link in the IHCA chain-of-survival, yet post-resuscitation survival has remained stagnant over time. Hypothesis We hypothesized substantial hospital-to-hospital variation exists in risk-standardized post-resuscitation survival rate (RSSR) and hospital-area social deprivation is associated with worse RSSR. Methods We performed a cohort study of the American Heart Association Get With The Guidelines®-Resuscitation registry, linked to the American Hospital Association survey. We included adult IHCA patients with sustained return of spontaneous circulation (ROSC) from 2001-2024. Post-resuscitation RSSR was the ratio of the predicted (hospital-specific average of patient-level predictions from mixed-effects model) to expected (adjusted population-averaged predictions) survival, multiplied by the unadjusted full-cohort survival. Social deprivation index (SDI) was assigned by ZIP-to-ZCTA linkage and analyzed by quartile. Hospitals lacking ZCTA linkage were excluded from SDI analyses. Results Of 686,273 IHCA, 206,467 from 755 hospitals were included for primary analysis. Overall, 71,691 (34.7%) patients who achieved ROSC survived to discharge. Median RSSR was 33.9% (IQR 32.6-35.1%). Variation in RSSR across hospitals was substantial—ranging from 25.0 to 44.8%. A total of 595 (78.8%) hospitals were linked by zip-code to SDI. Patients at hospitals in the lowest quartile of SDI (least deprivation) had higher post-resuscitation RSSR compared to patients in the highest quartile (aOR 1.13, 95% CI 1.03-1.23, p<0.01), although no monotonic relationship existed between hospital SDI quartile and RSSR quartile. Hospitals in higher SDI quartiles (more deprivation) had higher proportions of early post-resuscitation fever and death. Conclusions Substantial hospital-to-hospital variation exists in post-resuscitation survival, and greater community social deprivation predicts worse post-resuscitation outcomes at the patient level. These results identify the post-resuscitation phase of care as a promising area for future quality improvement and research efforts to improve outcomes after IHCA.
Andrea et al. (Fri,) studied this question.