Improving survival after in-hospital cardiac arrest (IHCA) remains a major challenge despite widespread implementation of cardiopulmonary resuscitation (CPR) quality initiatives. A cohort study published in JAMA Cardiology evaluated whether adoption of the Resuscitation Quality Improvement (RQI) program was associated with improved IHCA outcomes compared with matched non-RQI hospitals.

The analysis included 237 US hospitals participating in the Get With The Guidelines–Resuscitation registry between 2017 and 2023. Control hospitals were matched to RQI hospitals according to similar preintervention risk-standardized survival rates (RSSR) and annual IHCA case volumes.

A difference-in-differences analysis compared 2-year post-implementation versus pre-implementation outcomes between hospitals adopting the RQI program and matched control hospitals. The study included 49,870 in-hospital cardiac arrest events across 237 hospitals, including 18 RQI hospitals and 107 matched control hospitals.

Findings

• Mean risk-standardized survival to hospital discharge at RQI hospitals decreased from 25.3% before implementation to 21.2% after implementation, while survival at control hospitals declined from 25.0% to 21.5%.
• RQI adoption was not associated with improved survival to hospital discharge compared with control hospitals (difference-in-differences adjusted odds ratio [OR], 0.95; 95% confidence interval [CI], 0.81-1.10; P = .48).
• Mean risk-standardized return of spontaneous circulation (ROSC) rates at RQI hospitals decreased from 73.4% to 69.1%, while ROSC rates at control hospitals decreased from 70.9% to 69.1%.
• RQI adoption was not associated with higher ROSC rates compared with control hospitals (difference-in-differences adjusted OR, 0.98; 95% CI, 0.81-1.18; P = .85).

Hospital adoption of the RQI program was not associated with improved survival to discharge or ROSC after IHCA during the first 2 years after implementation. The findings suggest that CPR-focused training programs alone may not be sufficient to improve IHCA outcomes.