Policy and practice changes could improve in-hospital cardiac arrest care, authors say

American Heart Association Scientific Advisory

Policy and practice changes by healthcare institutions, providers and others could greatly improve medical care and improve survival for people who have a sudden cardiac arrest in the hospital, according to an American Heart Association consensus statement in its journal, Circulation.

Each year, more than 200,000 adults and 6,000 children have in-hospital cardiac arrests, and survival has remained essentially unchanged for decades, statement authors said. According to the American Heart Association, only 24.2 percent of in-hospital cardiac arrest patients survive to hospital discharge.

Much more could be done to improve in-hospital cardiac arrest care by providers, institutions and the healthcare system, authors said.

A big obstacle to better care for in-hospital cardiac arrest is the inability to gather reliable data, said Laurie Morrison, M.D., M.Sc., statement lead author. "We must be able to count how many in-hospital cardiac arrests occur and report comparable outcomes across institutions - and apply the science to everyday care more quickly," said Morrison, also the Robert and Dorothy Pitts Chair in Acute Care & Emergency Medicine at St. Michael's Hospital in Toronto.

The statement's key recommendations include:

• Establishing competency of all hospital staff in recognizing a cardiac arrest, performing chest compressions and using an automated external defibrillator or AED.
• Ensuring that best practices are used in all stages of care for cardiac arrest.
• Requiring that all in-hospital cardiac arrests be reported, with survival data, using consistent definitions across hospitals. Definitions currently are not standardized, researchers said.
• Mandating that hospitals report rates per 1,000 admissions of do-not-attempt-to-resuscitate orders among patients before an arrest occurs. Variation in reporting and implementing these orders can dramatically skew data about patient outcomes.
• Modifying billing codes to allow collection of more specific and accurate data for in-hospital cardiac arrest. The authors also suggest separate guidelines for in-hospital versus out-of-hospital cardiac arrests.