Incidence, Process of Care, and Outcomes of In-Hospital Cardiac Arrest in China: A Multicenter Prospective Registry Study

Abstract

BACKGROUND: In-hospital cardiac arrest (IHCA) is an acute event associated with high mortality. Although survival has improved in high-income countries, contemporary multicenter data from low- and middle-income countries remain scarce, limiting global benchmarking and the identification of system-level opportunities for improvement. METHODS: This cohort study used data from the BASIC-IHCA (Baseline Investigation of In-Hospital Cardiac Arrest) registry. Adult patients (≥18 years) who experienced IHCA and received cardiopulmonary resuscitation between July 1, 2019, and December 31, 2020, at 37 hospitals across 29 provinces in China were included. The primary outcome was survival to 30 days or hospital discharge. Secondary outcomes included return of spontaneous circulation, 6- and 12-month survival, and favorable neurological outcome (Cerebral Performance Category score 1–2). Process measures focused on the timeliness of resuscitation response and the implementation of postresuscitation interventions. RESULTS: Among 17 602 patients (median age, 66 years; 65.5% male), the annual incidence of adult IHCA was 4.1 per 1000 admissions. Cardiac etiology was identified in 6569 (37.3%) patients, and 2380 (13.5%) presented with initial shockable rhythm. Among all patients, 16 872 (95.9%) received cardiopulmonary resuscitation within 1 minute; timely defibrillation or epinephrine was achieved in 71.4% and 84.4% of patients with initial shockable and nonshockable rhythms, respectively. Sustained return of spontaneous circulation was achieved in 6200 (35.2%) patients, of whom 222 (3.6%) received temperature control therapy and 320 (5.2%) underwent coronary angiography. Overall, 1610 (9.1%) patients survived to 30 days or discharge, with 1241 (7.1%) having a favorable neurological outcome. At 12 months, 1075 (6.1%) patients remained alive, and 986 (5.6%) had a favorable neurological outcome. CONCLUSIONS: This multicenter registry highlights a substantial burden of IHCA in China, with markedly low survival rates. Despite prompt initial resuscitation, critical gaps persist in postresuscitation care. Systemic and cultural factors, including the infrequent use of do not attempt cardiopulmonary resuscitation orders, may further contribute to survival disparities. These findings suggest several system-level opportunities to improve IHCA outcomes, including structured response systems, optimized critical care resource allocation, and greater integration of advanced care planning.