Why is this important?

In-hospital cardiac arrest (IHCA) training is an important component of both foundational and continuing medical education. Nonetheless patient survival after IHCA continues to vary across institutions, making it a priority for improvement.

What did they do?

Josey and team set out to identify whether greater hospital use of in-situ AHCI drills (‘in-situ mock codes’ - ISMC) was associated with improved IHCA survival. They measured both hospital-level simulation participation and IHCA discharge survival rates across 26 hospitals in their US multi-state non-profit health system.

And they found?

Hospitals with more active in-hospital cardiac arrest simulation training also had better IHCA survival (43% vs 32%, OR 0.62), even after adjusting for case-mix and acuity.

It is reasonable to conclude that better in-hospital code training leads to better basic & advanced life support and thus better IHCA survival – suggested, for example, by their observation of shorter time to defibrillation during arrest drills among high participation hospitals.

In fact they extraopated that each additional 1.1 drill/100 beds/year equated with one extra life saved. Interestingly the benefit of ISMC held up for large and medium-sized hospitals, but not small hospitals (=< 25 beds).

Be smart

Whether these results represent a direct casual effect of simulation training to improve survival, or an indirect effect of hospital safety culture on both simulation participation and patient survival, it is nonetheless an important result.

Plus a great example of studying a meaningful outcome (survival to discharge) instead of surrogate markers often employed in resuscitation and simulation research.

summary

• Karen Josey, Marshall L Smith, Arooj S Kayani, Geoff Young, Michael D Kasperski, Patrick Farrer, Richard Gerkin, Andreas Theodorou, and Robert A Raschke.
• Banner Simulation System, Banner Health, United States.
• Resuscitation. 2018 Dec 1; 133: 47-52.

AimThe American Heart Association (AHA) and the Institute of Medicine have published a national "call-to-action" to improve survival from in-hospital cardiopulmonary arrest (IHCA). Our aim was to determine if more-active hospital participation in standardized in-situ mock code (ISMC) training is associated with increased IHCA survival.MethodsWe performed an ecological study across a multi-state healthcare system comprising 26 hospitals. Hospital-level ISMC performance was measured during 2016-2017 and IHCA hospital discharge survival rates in 2017. We performed univariate and multivariate analysis of the hospital-level association between more-active ISCM participation and IHCA survival, with adjustment for hospital expected mortality as determined by a commercial severity scoring system. Other potential confounders were analyzed using univariate statistics.ResultsHospitals with more-active ISMC participation conducted a median of 17.6 ISMCs/100 beds/year (vs 3.2/100 beds/year in less-active hospitals, p = 0.001) in 2016-2017. 220,379 patients were admitted and 3289 experienced IHCA in study hospitals in 2017, with an overall survival rate of 37.4%. Hospitals with more-active ISMC participation had a mean IHCA survival rate of 42.8% vs. 31.8% in hospitals with less-active ISMC participation (p < 0.0001), and a significantly reduced odds ratio (OR) of 0.62 for IHCA mortality (95% CI: 0.54-0.72; p < 0.0001) which was unchanged after adjustment for hospital-level expected mortality (adjusted OR: 0.62; 95% CI: 0.54-0.71; p < 0.001).ConclusionsHospitals in our healthcare system with more-active ISMC participation have higher IHCA survival. Prospective trials are needed to establish the efficacy of standardized ISMC training programs in improving patient survival after cardiac arrest.Copyright © 2018 Elsevier B.V. All rights reserved.

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