Hospitals with more-active participation in conducting standardized in-situ mock codes have improved survival after in-hospital cardiopulmonary arrest

Karen Josey, Marshall L. Smith, Arooj S. Kayani, Geoff Young, Michael D. Kasperski, Patrick Farrer, Richard Gerkin, Andreas Theodorou, Robert A. Raschke

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Aim: The American Heart Association (AHA) and the Institute of Medicine have published a national “call-to-action” to improve survival from in-hospital cardiopulmonary arrest (IHCA). Our aim was to determine if more-active hospital participation in standardized in-situ mock code (ISMC) training is associated with increased IHCA survival. Methods: We performed an ecological study across a multi-state healthcare system comprising 26 hospitals. Hospital-level ISMC performance was measured during 2016–2017 and IHCA hospital discharge survival rates in 2017. We performed univariate and multivariate analysis of the hospital-level association between more-active ISCM participation and IHCA survival, with adjustment for hospital expected mortality as determined by a commercial severity scoring system. Other potential confounders were analyzed using univariate statistics. Results: Hospitals with more-active ISMC participation conducted a median of 17.6 ISMCs/100 beds/year (vs 3.2/100 beds/year in less-active hospitals, p = 0.001) in 2016–2017. 220,379 patients were admitted and 3289 experienced IHCA in study hospitals in 2017, with an overall survival rate of 37.4%. Hospitals with more-active ISMC participation had a mean IHCA survival rate of 42.8% vs. 31.8% in hospitals with less-active ISMC participation (p < 0.0001), and a significantly reduced odds ratio (OR) of 0.62 for IHCA mortality (95% CI: 0.54–0.72; p < 0.0001) which was unchanged after adjustment for hospital-level expected mortality (adjusted OR: 0.62; 95% CI: 0.54–0.71; p < 0.001). Conclusions: Hospitals in our healthcare system with more-active ISMC participation have higher IHCA survival. Prospective trials are needed to establish the efficacy of standardized ISMC training programs in improving patient survival after cardiac arrest.

Original languageEnglish (US)
Pages (from-to)47-52
Number of pages6
JournalResuscitation
Volume133
DOIs
StatePublished - Dec 2018

Keywords

  • Basic life support
  • Cardiopulmonary resuscitation
  • Ecological study design
  • In-hospital cardiopulmonary arrest
  • In-situ mock code
  • Mortality
  • Simulation

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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