Physician resuscitation champions associated with higher rates of surviving in-hospital cardiac arrest

In a survey study, hospitals that had a very active physician champion of Get With the Guidelines—Resuscitation were four times more likely to be in a higher survival quintile than participating hospitals that did not.

Physician resuscitation champions who are very active in their roles may help improve patients' survival of in-hospital cardiac arrest, according to a recent study.

Researchers surveyed hospitals participating in the Get With the Guidelines—Resuscitation program about their resuscitation practices and categorized them as having a very active physician champion, a very active nonphysician champion, or other (no champion or a champion who was not very active). Hospitals that had both a physician and a nonphysician champion were considered to be in the physician champion group. The researchers then determined quintiles of risk-standardized survival rates for in-hospital cardiac arrest from Jan. 1, 2016, through Dec. 31, 2018, and used multivariable hierarchical proportional odds logistic regression to examine quintile association with champion type. The primary outcome was the proportion of a hospital's patients with in-hospital cardiac arrest who survived to hospital discharge, while the secondary outcome was the proportion of patients with favorable neurological survival. The study results were published Feb. 15 by the Journal of the American Heart Association.

A total of 192 hospitals with 44,477 in-hospital cardiac arrests were included in the study cohort. The median rate for survival of in-hospital cardiac arrest was 24.7% (range, 9.2% to 37.5%). Overall, 29 hospitals (15.1%) had very active physician champions, 64 (33.3%) had very active nonphysician champions, and 99 (51.6%) had either no champion or a champion who was not very active. Hospitals with a very active physician champion were four times more likely to be in a higher survival quintile than hospitals without a very active champion (odds ratio [OR], 4.39; 95% CI, 1.89 to 10.23), even after adjustment for resuscitation practices across hospital groups (adjusted OR, 3.90; 95% CI, 1.39 to 10.95). Survival did not differ between sites without very active champions and those with very active nonphysician champions (adjusted OR, 1.28; 95% CI, 0.62 to 2.65).

The researchers noted that survey responses were not independently confirmed, that only hospitals participating in Get With the Guidelines—Resuscitation were included, and that they could explain only part of the difference in survival by champion type. They concluded that based on their findings, the background and engagement level of a resuscitation champion are critical to a hospital's survival outcomes in patients with in-hospital cardiac arrest. Better compliance with process-of-care measures did not explain the differences in survival, and resuscitation practices such as use of devices to monitor CPR quality explained these differences only partly, the authors said.

“This suggests that the higher survival rates at sites with a very active physician champion are likely mediated by other quality measures (eg, improved post-resuscitation care in the intensive care unit and delivery of more consistent and effective chest compressions during an acute resuscitation) and leadership activities (eg, building a culture of teamwork and communication during acute resuscitations) not captured in our study survey,” they wrote. “Identification of what these other programs or activities are warrants further study in order to disseminate best practices in resuscitation care.”

An accompanying editorial noted that the lack of effect of a nonphysician champion was surprising and might be due to classification bias, since hospitals with both physician and nonphysician champions were considered to be in the former group and physician and nonphysician champions could therefore not be directly compared. The editorialists also called for further work to explain the potential benefit of engaged champions in improving resuscitation survival rates and to continue to define the role of champions in this area. “Building a successful resuscitation system of care may in fact rely on building a culture around such champions. We should continue to attempt to further characterize engaged and effective champions and their impact in an effort to strengthen the Chain of Survival,” they wrote.