Introduction

In-hospital resuscitation practices have changed very little despite significant advances in resuscitation science. Unlike pre-hospital providers, hospital personnel have been slow to focus on resuscitation practices and even slower to adopt evolving science and technology to improve outcomes. Consequently, there has been no improvement in survival over time for hospitalized patients suffering a cardiorespiratory arrest, where overall survival remains approximately 18%.

Hospitalized patients have different comorbidities from persons who arrest outside of the hospital. In a large series of cardiorespiratory arrests occurring in hospitalized patients in the United States, many arrest patients had electrocardiographic or oximetry monitoring, an invasive airway, or were receiving an intravenous vasoactive drug prior to their arrest, suggesting that this population has varying degrees of underlying instability. Nevertheless, to stop here and suggest that survival will always be poor because the patients are “sick” and cannot be expected to do well leads to a self-fulfilling prophecy. Although the hospitalized patient population may inherently be more acutely ill, the hospital also has potential resources that far outweigh those in the pre-hospital setting.

Different strategies may be necessary to improve survival in the hospital environment. One of the most significant changes that must occur is within the hospital culture. Attention needs to be focused on the science of resuscitation, and on the process of care delivery. The importance of administrative and organizational support is paramount to achieving success. Traditionally, hospitals focus only on the arrest event itself when planning their resuscitation practices. Little attention is given to prevention or the specific care the patient receives after return of spontaneous circulation (ROSC).