Abstract
BACKGROUND: In-hospital cardiac arrest (IHCA) survival has improved over the past two decades, resulting from better acute resuscitation survival. Post-resuscitation care is a key link in the IHCA chain-of-survival, yet post-resuscitation survival has remained stagnant over time. HYPOTHESIS: We hypothesized substantial hospital-to-hospital variation exists in risk-standardized post-resuscitation survival rate (RSSR) and hospital-area social deprivation is associated with worse RSSR. METHODS: We performed a cohort study of the American Heart Association Get With The Guidelines(®)-Resuscitation registry, linked to the American Hospital Association survey. We included adult IHCA patients with sustained return of spontaneous circulation (ROSC) from 2001-2024. Post-resuscitation RSSR was the ratio of the predicted (hospital-specific average of patient-level predictions from mixed-effects model) to expected (adjusted population-averaged predictions) survival, multiplied by the unadjusted full-cohort survival. Social deprivation index (SDI) was assigned by ZIP-to-ZCTA linkage and analyzed by quartile. Hospitals lacking ZCTA linkage were excluded from SDI analyses. RESULTS: Of 686,273 IHCA, 206,467 from 755 hospitals were included for primary analysis. Overall, 71,691 (34.7%) patients who achieved ROSC survived to discharge. Median RSSR was 33.9% (IQR 32.6-35.1%). Variation in RSSR across hospitals was substantial-ranging from 25.0 to 44.8%. A total of 595 (78.8%) hospitals were linked by zip-code to SDI. Patients at hospitals in the lowest quartile of SDI (least deprivation) had higher post-resuscitation RSSR compared to patients in the highest quartile (aOR 1.13, 95% CI 1.03-1.23, p<0.01), although no monotonic relationship existed between hospital SDI quartile and RSSR quartile. Hospitals in higher SDI quartiles (more deprivation) had higher proportions of early post-resuscitation fever and death. CONCLUSIONS: Substantial hospital-to-hospital variation exists in post-resuscitation survival, and greater community social deprivation predicts worse post-resuscitation outcomes at the patient level. These results identify the post-resuscitation phase of care as a promising area for future quality improvement and research efforts to improve outcomes after IHCA.