Up to one-third or more of inpatient cardiac arrest deaths may be avoidable, either through arrest prevention efforts or via improved resuscitative measures. Unfortunately, hospitals have struggled to implement effective programs that reduce the incidence of cardiac arrest, and inpatient arrest survival rates have been relatively stagnant for decades.
Based on a recent Society of Hospital Medicine survey, most hospitals use biennial life support training as their sole source for maintaining resuscitation competency among their providers. This is too infrequent and doesn’t address the unique hospital-based resources and technology that could contribute to arrest outcomes. In addition, many hospitals don’t even maintain a dedicated committee to review cardiac arrest performance. Finally, traditional life support training doesn’t incorporate arrest prevention, which is a unique opportunity in the inpatient environment.
Hospitals should develop a system of care for resuscitation that includes the following critical elements:
- A multidisciplinary committee responsible for cardiac arrest outcomes, including both incidence and survival. This group should have access to clinical outcomes and process data, and should have influence over training and other interventions to address identified opportunities for improvement
- Data collection, which should include both arrest incidence and survival, as well as process measures that quantify the response and resuscitation performance. The measures should reflect opportunities for arrest prevention and should ideally include specific therapies such as chest compressions, ventilations, defibrillation and medications
- Routine and ad lib educational or training opportunities should be considered mechanisms to achieve and maintain competency as identified by data collection mechanisms—hospitals should abandon the notion that biennial training is adequate to maintain resuscitation competency.
Hospitals that have adopted a system of care approach to resuscitation have demonstrated dramatic reductions in arrest incidence as well as improvements in survival-to-discharge for arrest victims. Prevention efforts are particularly impactful in the non-ICU setting, where reductions in arrest incidence of 50% or greater have been observed consistently following implementation of a resuscitation system of care that incorporates prevention efforts.
With regard to arrest survival, survival-to-discharge rates have consistently doubled and good neurological outcomes tripled following implementation of adaptive resuscitation training that focuses on high quality CPR performance and integration of technology to enhance performance. Together, efforts to reduce arrest incidence and improve survival can reduce arrest-related deaths by up to 75%. This has resulted in absolute mortality reductions of 20% or greater and risk-adjusted mortality reductions of more than 40%.
Implementing a resuscitation system of care is associated with several important challenges that must be addressed for these efforts to be successful:
- The current resuscitation perspective is oriented toward fulfilling regulatory requirements rather than improving clinical care. This represents a major challenge to create cultural change.
- Establishing a resuscitation committee may involve compensation to key leaders to ensure ownership and accountability as well as additional responsibilities for committee members.
- Collection and analysis of additional data elements involves hospital resource allocation. Our experience with de novo implementation suggests that 0.2–0.5 FTE for a data analyst will be required, depending on the intensity of data collection.
- Additional education/training sessions for providers may be a significant cost requirement for these programs. Prior experience documents a cost-per-life saved of $100–$2,000, depending on the breadth and format of training exposures.