Resuscitation Quality Improvement Program Fails to Improve In-Hospital Cardiac Arrest Survival Outcomes: Study
USA: A national cohort study found that hospitals adopting the RQI (Resuscitation Quality Improvement) CPR training program did not achieve better rates of return of spontaneous circulation (ROSC) or survival to discharge over 2 years compared with control hospitals. The findings suggest that improving CPR delivery alone may be insufficient to significantly enhance outcomes after in-hospital cardiac arrest (IHCA).
A recent study published in JAMA Cardiology by Paul S. Chan and colleagues from Saint Luke’s Mid America Heart Institute evaluated whether structured, high-frequency CPR training through the Resuscitation Quality Improvement (RQI) program translates into improved patient outcomes. The program, introduced widely across US hospitals since 2018, emphasizes quarterly training sessions aimed at improving skill retention and CPR quality.
To assess its real-world effectiveness, the investigators conducted a large cohort study involving 237 hospitals participating in the Get With The Guidelines–Resuscitation registry between 2017 and 2023. Among these, 18 hospitals that implemented the RQI program were matched with 107 control hospitals that did not adopt the intervention. Matching was based on similar baseline survival rates and cardiac arrest case volumes, ensuring comparability between groups. The researchers applied a difference-in-differences analytical approach to evaluate changes in outcomes over two years before and after RQI implementation.
The analysis included nearly 50,000 cases of in-hospital cardiac arrest.
The study led to the following findings:
- Survival to hospital discharge declined over time in both RQI and control hospitals.
- At RQI hospitals, risk-standardized survival decreased from 25.3% before implementation to 21.2% after implementation.
- Control hospitals also showed a similar decline, from 25.0% to 21.5%.
- RQI adoption was not associated with improved survival to discharge (adjusted odds ratio 0.95).
- Return of spontaneous circulation (ROSC) rates also declined in both groups over time.
- At RQI hospitals, ROSC decreased from 73.4% to 69.1%.
- In control hospitals, ROSC declined from 70.9% to 69.1%.
- RQI implementation was not associated with improved ROSC rates (adjusted odds ratio 0.98).
The findings highlight that while maintaining high-quality CPR is a critical component of resuscitation care, focusing exclusively on training may not be enough to improve survival outcomes. Cardiac arrest survival depends on multiple factors, including timely recognition, rapid response systems, post-resuscitation care, and overall hospital processes.
The authors noted several limitations. Despite adjustments for patient and arrest-related factors, residual confounding cannot be ruled out. Individual-level CPR performance data were unavailable, and other concurrent quality improvement efforts were not captured. As the registry represents only a subset of US hospitals, the findings may have limited generalizability.
Overall, the study highlights the need for a broader, system-level approach to improving IHCA outcomes. While programs like RQI may enhance CPR skills, integrating them with comprehensive strategies targeting the entire chain of survival may be essential to achieve meaningful gains in patient survival.
Reference:
Chan PS, Bradley SM, Spertus JA, et al. Resuscitation Quality Improvement Program for CPR Training and Cardiac Arrest Survival in Hospitals. JAMA Cardiol. Published online May 20, 2026. doi:10.1001/jamacardio.2026.1074
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