Incidence, Process of Care, and Outcomes of In-Hospital Cardiac Arrest in China: A Multicenter Prospective Registry Study
In brief
Only 9% of Chinese patients with in-hospital cardiac arrest survived to discharge
In a prospective registry of 17,602 adults at 37 hospitals, 9.1% survived to 30 days or hospital discharge, and 7.1% had a favorable neurological outcome. Although nearly all received CPR within one minute, post-arrest treatments were uncommon, pointing to care gaps beyond the initial response; the registry identifies opportunities for improvement but does not test which changes will work.
- Journal
- Circulation (Q1)
- Published
- 6 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Chunyi Wang, Jiaqi Zheng, Wen Zheng, Kehui Yang, Xianliang Yan, Yage Chai, et al.
- PMID
- 42836281
- DOI
- 10.1161/CIRCULATIONAHA.126.080404
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 11 October 2026): Multicenter registry of in‑hospital cardiac arrest in China
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.