Race and Resuscitation: Evolving Trends in Survival After In‐Hospital Cardiac Arrest

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Background Survival after in‐hospital cardiac arrest has improved over the past 2 decades, yet prior studies have documented worse outcomes among Black compared with White patients. Although the racial survival gap narrowed through 2014, it remains unclear whether disparities persist in more recent years. Methods We conducted an observational cohort study using in‐hospital cardiac arrest data from the Get With The Guidelines–Resuscitation registry from 2015 to 2022. Multivariable models using generalized estimating equations evaluated the association between patient race (White versus Black) and survival to hospital discharge, accounting for clustering by hospital. Secondary outcomes included return of spontaneous circulation and favorable neurological survival (ie, survival without severe neurologic disability). Models were adjusted for patient, arrest, and hospital characteristics. Results Among 156 528 patients, 40 874 were Black and 115 654 were White. Black patients were younger, more often female, and had higher rates of diabetes, renal insufficiency, and respiratory insufficiency, whereas White patients had more prior myocardial infarctions. After adjustment, survival to discharge was similar between races (23.2% versus 20.0%; adjusted odds ratio [aOR], 1.03 [95% CI, 0.99–1.00], P =0.11), as were return of spontaneous circulation rates (68.1% versus 64.4%; aOR, 0.99 [95% CI, 0.97–1.02], P =0.62). However, White patients had higher favorable neurological survival (16.0% versus 12.6%; aOR, 1.10 [95% CI, 1.05–1.14], P <0.001). These findings remained consistent across years and were unchanged when adjusting for hospitals with high versus low proportions of Black patients. Conclusions Although racial differences in survival to discharge have largely resolved, disparities in favorable neurological outcomes persist, suggesting potentially modifiable differences in postresuscitation care.

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