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

Importance: Since 2018, the Resuscitation Quality Improvement (RQI) program to enhance cardiopulmonary resuscitation (CPR) training and skill retention has expanded to many US hospitals. Objective: To evaluate whether adoption of the RQI program is associated with higher in-hospital cardiac arrest (IHCA) survival, compared with control (non-RQI) hospitals. Design, Setting, and Participants: 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. Exposure: Hospital adoption of RQI program. Main Outcomes and Measures: RSSR to hospital discharge and return of spontaneous circulation (ROSC). Results: 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). Conclusions and Relevance: 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.