Abstract 11679: Post-resuscitation Care and Survival After In-hospital Cardiac Arrest

Background: More than 40% of in-hospital cardiac arrest (IHCA) deaths occur in patients during the post-resuscitation period following return of spontaneous circulation (ROSC). However, the degree to which post-resuscitation survival varies across hospitals and whether this variation is explained by hospital characteristics is unknown. Methods: We identified 80,201 patients within Get with the Guidelines-Resuscitation who achieved ROSC following IHCA. Using a multivariable hierarchical regression model, we calculated risk adjusted rates of post-resuscitation survival for each hospital and quantified hospital variation in post-resuscitation survival using median odds ratio (OR). We also assessed the association of hospital characteristics with post-resuscitation survival. Results: The mean age was 65.5 years, 57% were men, and 23% were black. Nearly 1 in 4 (23.0%) patients had an initial shockable rhythm. Overall, 33.5% of patients with ROSC survived to discharge, but the rate of post-resuscitation survival varied across hospitals (median hospital rate: 33.3%; interquartile range: 29.9%-36.7%; total range: 18.9%-55.1%). The median OR was 1.35 (95% CI: 1.30, 1.39, Figure), which suggests that post-resuscitation survival for 2 patients with similar covariates at 2 randomly selected hospitals varied by 35%. Except U.S. census region (P<0.001), no hospital characteristic was associated with hospital rates of post-resuscitation survival including, academic status, total bed number, hospital ownership, use of intensivists; number and proportion of intensive care unit [ICU] beds, neurological services, and coronary angiography capability. Conclusions: Rates of post-resuscitation survival vary among U.S. hospitals. However, this variation is not explained by hospital structural characteristics, thus highlighting a pressing need to identify post-resuscitation best practices at top-performing hospitals in post-cardiac arrest care.