• Patrick G Lyons, Joe Reid, Sara Richardville, and Dana P Edelson.
• Department of Medicine, University of Chicago School of Medicine, United States; Now with the Department of Medicine, Oregon Health & Science University, United States. Electronic address: lyonspa@ohsu.edu.
• Resuscitation. 2024 Apr 1; 197: 110161110161.

AimHospital rapid response systems aim to stop preventable cardiac arrests, but defining preventability is a challenge. We developed a multidisciplinary consensus-based process to determine in-hospital cardiac arrest (IHCA) preventability based on objective measures.MethodsWe developed an interdisciplinary ward IHCA debriefing program at an urban quaternary-care academic hospital. This group systematically reviewed all IHCAs weekly, reaching consensus determinations of the IHCA's cause and preventability across three mutually exclusive categories: 1) unpredictable (no evidence of physiologic instability < 1 h prior to and within 24 h of the arrest), 2) predictable but unpreventable (meeting physiologic instability criteria in the setting of either a poor baseline prognosis or a documented goals of care conversation) or 3) potentially preventable (remaining cases).ResultsOf 544 arrests between 09/2015 and 11/2023, 339 (61%) were deemed predictable by consensus, with 235 (42% of all IHCAs) considered potentially preventable. Potentially preventable arrests disproportionately occurred on nights and weekends (70% vs 55%, p = 0.002) and were more frequently respiratory than cardiac in etiology (33% vs 15%, p < 0.001). Despite similar rates of ROSC across groups (67-70%), survival to discharge was highest in arrests deemed unpredictable (31%), followed by potentially preventable (21%), and then those deemed predictable but unpreventable which had the lowest survival rate (16%, p = 0.007).ConclusionsOur IHCA debriefing procedures are a feasible and sustainable means of determining the predictability and potential preventability of ward cardiac arrests. This approach may be useful for improving quality benchmarks and care processes around pre-arrest clinical activities.Copyright © 2024 Elsevier B.V. All rights reserved.

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