Risk‐Standardizing Rates of Return of Spontaneous Circulation for In‐Hospital Cardiac Arrest to Facilitate Hospital Comparisons

Abstract

Background Sustained return of spontaneous circulation (ROSC) is the most proximal and direct assessment of acute resuscitation quality in hospitals. However, validated tools to benchmark hospital rates for ROSC after in‐hospital cardiac arrest currently do not exist. Methods and Results Within the national Get With The Guidelines‐Resuscitation registry, we identified 83 206 patients admitted from 335 hospitals from 2014 to 2017 with in‐hospital cardiac arrest. Using hierarchical logistic regression, we derived and validated a model for ROSC, defined as spontaneous and sustained ROSC for ≥20 consecutive minutes, from 24 pre‐arrest variables and calculated rates of risk‐standardized ROSC for in‐hospital cardiac arrest for each hospital. Overall, rates of ROSC were 72.0% and 72.7% for the derivation and validation cohorts, respectively. The model in the derivation cohort had moderate discrimination (C‐statistic 0.643) and excellent calibration ( R 2 of 0.996). Seventeen variables were associated with ROSC, and a parsimonious model retained 10 variables. Before risk‐adjustment, the median hospital ROSC rate was 70.5% (interquartile range: 64.7–76.9%; range: 33.3–89.6%). After adjustment, the distribution of risk‐standardized ROSC rates was narrower: median of 71.9% (interquartile range: 68.2–76.4%; range: 42.2–84.6%). Overall, 56 (16.7%) of 335 hospitals had at least a 10% absolute change in percentile rank after risk standardization: 27 (8.0%) with a ≥10% negative percentile change and 29 (8.7%) with a ≥10% positive percentile change. Conclusions We have derived and validated a model to risk‐standardize hospital rates of ROSC for in‐hospital cardiac arrest. Use of this model can support efforts to compare acute resuscitation survival across hospitals to facilitate quality improvement.