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.
Source: American Heart Association
