Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes

Improving in-hospital cardiac arrest (IHCA) quality of care for adult and pediatric patients—not simply survival—requires a comprehensive set of programs and actions. Ideally, these should be embedded in a system of care that (1) plans and prepares for IHCA, (2) prevents IHCA when avoidable, (3) delivers high-quality, guideline-based resuscitation, and (4) continuously evaluates and improves itself within a culture of person-centered care.

IHCA is a high-risk event among hospitalized patients of all ages worldwide that is associated with significant morbidity and mortality.1 Estimates of its incidence vary across industrialized countries with rates in adults between 1.2 and 10 per 1000 hospital admissions,2, 3, 4, 5 which translates to ≈300 000 IHCA events in the United States each year with a reported survival rate to hospital discharge of ≈25%.5 Although experiences outside of higher income countries are limited, reported data suggest high incidence rates of IHCA in low- to middle-income countries like Uganda and China.6, 7 These events are medical emergencies that require immediate treatment by teams of interdisciplinary health care professionals to optimize outcomes. Not surprisingly, there is a significant burden on hospitals to create and maintain resuscitation systems that are able to identify IHCA, activate an emergency response, and deliver high-quality resuscitation. Yet despite these pressures, there is consistent evidence that the quality of care around IHCA remains suboptimal and varies across hospitals and countries.8, 9, 10.

Given the variation in IHCA quality of care and outcomes, the International Liaison Committee on Resuscitation (ILCOR) launched an initiative to provide strategic guidance delineating critical steps to improve IHCA care. The member councils comprising ILCOR are the American Heart Association, European Resuscitation Council, Heart and Stroke Foundation of Canada, Australian and New Zealand Committee on Resuscitation, Resuscitation Councils of Asia, Indian Resuscitation Council Federation, and the collaborating organization, International Federation of Red Cross. The Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes in this document (Fig. 1; Table 1) is the result of this effort and builds upon prior work in the space of out-of-hospital cardiac arrest care by the Global Resuscitation Alliance.11 These steps represent the consensus of a Writing Group of >30 interprofessional experts drawn from various branches of medicine, nursing, and allied health care professions.