Elsevier

Resuscitation

Volume 183, February 2023, 109686
Resuscitation

Clinical paper
Updating the model for Risk-Standardizing survival for In-Hospital cardiac arrest to facilitate hospital comparisons

https://doi.org/10.1016/j.resuscitation.2022.109686Get rights and content

Abstract

Background

Risk-standardized survival rates (RSSR) for in-hospital cardiac arrest (IHCA) have been widely used for hospital benchmarking and research. The novel coronavirus 2019 (COVID-19) pandemic has led to a substantial decline in IHCA survival as COVID-19 infection is associated with markedly lower survival. Therefore, there is a need to update the model for computing RSSRs for IHCA given the COVID-19 pandemic.

Methods

Within Get With The Guidelines®-Resuscitation, we identified 53,922 adult patients with IHCA from March, 2020 to December, 2021 (the COVID-19 era). Using hierarchical logistic regression, we derived and validated an updated model for survival to hospital discharge and compared the performance of this updated RSSR model with the previous model.

Results

The survival rate was 21.0% and 20.8% for the derivation and validation cohorts, respectively. The model had good discrimination (C-statistic 0.72) and excellent calibration. The updated parsimonious model comprised 13 variables—all 9 predictors in the original model as well as 4 additional predictors, including COVID-19 infection status. When applied to data from the pre-pandemic period of 2018–2019, there was a strong correlation (r = 0.993) between RSSRs obtained from the updated and the previous models.

Conclusion

We have derived and validated an updated model to risk-standardize hospital rates of survival for IHCA. The updated model yielded RSSRs that were similar to the initial model for IHCAs in the pre-pandemic period and can be used for supporting ongoing efforts to benchmark hospitals and facilitate research that uses data from either before or after the emergence of COVID-19.

Keywords

Cardiac arrest
Survival
Risk-adjustment

Cited by (0)

1

The American Heart Association Get With The Guidelines–Resuscitation investigators are listed in the Appendix A section.

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