In-hospital cardiac arrest survival before and after the COVID-19 pandemic: Have higher performing hospitals stayed high-performing?

• Published in: Resuscitation Vol. 203; p. 110374
• Main Authors: Khan, Mirza S., Kennedy, Kevin F., Chan, Paul S.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2024
• Subjects: Advanced Cardiac Life Support; Aged; Cardiopulmonary Resuscitation; COVID-19; COVID-19 - epidemiology; COVID-19 - mortality; Female; Heart Arrest - epidemiology; Heart Arrest - mortality; Heart Arrest - therapy; Hospital Mortality - trends; Hospitals - standards; Hospitals - statistics & numerical data; Humans; In-Hospital Cardiac Arrest; Male; Middle Aged; Pandemics; Registries; Resuscitation; SARS-CoV-2; Survival Rate - trends; United States - epidemiology; United States; COVID-19; Advanced Cardiac Life Support; In-Hospital Cardiac Arrest; Resuscitation
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2024.110374

Survival for in-hospital cardiac arrest (IHCA) has declined since the COVID-19 pandemic. Because the burden of COVID-19 was uneven throughout the U.S., it remains unknown if top-performer hospitals in IHCA survival have remained top-performers since the pandemic. Within Get With The Guidelines®-Resuscitation, we identified hospitals with at least 2 years of registry participation pre-pandemic (2017–2019) and post-pandemic (July 2020–2022) and with at least 20 IHCA cases in both periods. Using multivariable hierarchical models with hospital as a random effect and adjusting for patient and arrest characteristics, we calculated risk-standardized survival rates to discharge (RSSR) for IHCA at each hospital during the pre- and post-pandemic periods. We then assessed the correlation between a hospital’s pre-pandemic and post-pandemic RSSR for IHCA, and whether the correlation differed by the proportion of Black or Hispanic IHCA patients at each hospital. A total of 243 hospitals were included, comprising 122,561 IHCAs (pre-pandemic: 57,601; post-pandemic: 64,960). Pre-pandemic, the mean RSSR was 26.8% (SD, 5.2%) whereas the mean RSSR post-pandemic was 21.7% (SD, 5.5%). There was good correlation between a hospital’s pre- and post-pandemic RSSR: correlation of 0.55. When hospitals were categorized into tertiles based on the proportion of their IHCA patients who were Black or Hispanic, this correlation remained similar: 0.48, 0.68, and 0.45 (interaction P-value: 0.69) for hospitals in the upper, middle and lower tertiles, respectively. Although the COVID-19 pandemic affected the U.S. unevenly, there was good correlation in a hospital’s performance for IHCA survival before and after the pandemic, even at hospitals caring for a larger proportion of Black and Hispanic patients. Future studies are needed to understand what characteristics of high-performing hospitals pre-pandemic allowed many to continue to excel in the post-pandemic period.