IMPORTANCE In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. OBSERVATIONS In-hospital cardiac arrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital cardiac arrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiac arrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiac arrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiac arrest include chest compressions, ventilation, early defibrillation, when applicable, and immediate attention to potentially reversible causes, such as hyperkalemia or hypoxia. There is limited evidence to support more advanced treatments. Post–cardiac arrest care is focused on identification and treatment of the underlying cause, hemodynamic and respiratory support, and potentially employing neuroprotective strategies (eg, targeted temperature management). Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the Post–cardiac arrest period. Withdrawal of care in the absence of definite prognostic signs both during and after cardiac arrest should be avoided. Hospitals are encouraged to participate in national quality-improvement initiatives. CONCLUSIONS AND RELEVANCE An estimated 290 000 in-hospital cardiac arrests occur each year in the United States. However, there is limited evidence to support clinical decision making. An increased awareness with regard to optimizing clinical care and new research might improve outcomes.

Background: Previous incidence estimates may no longer reflect the current public health burden of cardiac arrest in hospitalized adult and pediatric patients across the United States. The aim of this study was to estimate the contemporary annual incidence of in-hospital cardiac arrest in adults and children across the United States and to describe trends in incidence between 2008 and 2017. Methods and Results: Using the Get With The Guidelines–Resuscitation registry, we developed a negative binomial regression model to estimate the incidence of index pulseless in-hospital cardiac arrest based on hospital-level characteristics. The model was used to predict the number of in-hospital cardiac arrests in all US hospitals, using data from the American Hospital Association Annual Survey. We performed separate analyses for adult (≥18 years) and pediatric (<18 years) cardiac arrests. Additional analyses were performed for recurrent cardiac arrests and pediatric patients requiring cardiopulmonary resuscitation for poor perfusion (nonpulseless events). The average annual incidence of in-hospital cardiac arrest in the United States was estimated at 292 000 (95% prediction interval, 217 600–503 500) adult and 15 200 pediatric cases, of which 7100 (95% prediction interval, 4400–9900) cases were pulseless cardiac arrests and 8100 (95% prediction interval, 4700–11 500) cases were nonpulseless events. The rate of adult cardiac arrests increased over time, while pediatric events remained more stable. When including both index and recurrent in-hospital cardiac arrests, the average annual incidence was estimated at 357 900 (95% prediction interval, 247 100–598 400) adult and 19 900 pediatric cases, of which 8300 (95% prediction interval, 4900–11 200) cases were pulseless cardiac arrests and 11 600 (95% prediction interval, 6400–16 700) cases were nonpulseless events. Conclusions: There are ≈292 000 adult in-hospital cardiac arrests and 15 200 pediatric in-hospital events in the United States each year. This study provides contemporary estimates of the public health burden of cardiac arrest among hospitalized patients.

There is inconclusive evidence to either support or refute the use of ECPR for OHCA and IHCA in adults and children. The quality of evidence across studies is very low.

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.