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AHA: In-hospital cardiac arrest outcomes need work

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Policy and practice changes by healthcare institutions, providers and others could greatly improve medical care and survival for people who have a sudden cardiac arrest in the hospital, according to an American Heart Association consensus statement.

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 association, only 24.2% 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 in the statement, which was published March 11 on the website of the journal Circulation.

A big obstacle to better care for in-hospital cardiac arrest is the inability to gather reliable data, said Laurie Morrison, MD, MSc, the statement’s 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 every-day care more quickly,” Morrison, of St. Michael’s Hospital in Toronto, said in a news release.

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.

• 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 are not standardized, the authors 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, the authors said.

• 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.

A PDF of the full statement is available at http://bit.ly/16mMdGY.

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