Association Between Hospital Resuscitation Team Leader Credentials and Survival Outcomes for In-hospital Cardiac Arrest

Vittal Hejjaji; Apurba K Chakrabarti; Brahmajee K Nallamothu; Theodore J Iwashyna; Sarah L Krein; Brad Trumpower; Marci Kennedy; Khaja Chinnakondepalli; Ali O Malik; Paul S Chan

doi:10.1016/j.mayocpiqo.2021.06.002

Association Between Hospital Resuscitation Team Leader Credentials and Survival Outcomes for In-hospital Cardiac Arrest

Mayo Clin Proc Innov Qual Outcomes. 2021 Oct 28;5(6):1021-1028. doi: 10.1016/j.mayocpiqo.2021.06.002. eCollection 2021 Dec.

Authors

Vittal Hejjaji^{1

2}, Apurba K Chakrabarti³, Brahmajee K Nallamothu^{3

4}, Theodore J Iwashyna^{3

4}, Sarah L Krein^{3

4}, Brad Trumpower³, Marci Kennedy¹, Khaja Chinnakondepalli¹, Ali O Malik^{1

2}, Paul S Chan^{1

2}

Affiliations

¹ Department of Cardiovascular Diseases, Saint Luke's Mid America Heart Institute, Kansas City, MO.
² Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO.
³ Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
⁴ Department of Internal Medicine, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.

Abstract

Objective: To assess whether survival rates for in-hospital cardiac arrest (IHCA) vary across hospitals depending on whether resuscitations are typically led by an attending physician, a physician trainee, or a nonphysician.

Patients and methods: In 2018, we conducted a survey of hospitals participating in the national Get with the Guidelines - Resuscitation registry for IHCA. Using responses from the question "Who typically leads codes at your institution?" we categorized hospitals on the basis of who typically leads their resuscitations: attending physician, physician trainee, or nonphysician. We then compared risk-adjusted hospital rates of return of spontaneous circulation, survival to discharge, and favorable neurological survival from 2015 to 2017 between these 3 hospital groups by using multivariable hierarchical regression.

Results: Overall, 193 hospitals completed the study survey, representing a total of 44,477 IHCAs (mean age, 65.0±15.5 years; 40.8% were women). Most hospitals had resuscitations led by physicians, with 121 (62.7%) led by an attending physician, 58 (30.0%) by a physician trainee, and 14 (7.3%) by a nonphysician. The risk-standardized rates of survival to discharge were similar across hospitals, regardless of whether resuscitations were typically led by an attending physician, a physician trainee, or a nonphysician (25.6%±4.8%, 25.9%±4.7%, and 25.7%±3.6%, respectively; P=.88). Similarly, there were no differences between the 3 groups in risk-adjusted rates of return of spontaneous circulation (71.7%±6.3%, 73%±6.3%, and 73.4%±6.4%; P=.30) and favorable neurological survival (21.6%±7.1%, 22.7%±6.1%, and 20.9%±6.5%; P=.50).

Conclusion: In hospitals in a national IHCA registry, IHCA resuscitations were usually led by physicians. However, there was no association between a hospital's typical resuscitation team leader credentials and IHCA survival outcomes.

Keywords: ACLS, Advanced Cardiac Life Support; ANOVA, analysis of variance; GWTG-R, Get with the Guidelines – Resuscitation; IHCA, in-hospital cardiac arrest; ROSC, return of spontaneous circulation; RSSR, risk-standardized survival rate.

Abstract

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