# ResCU II: Improving In-hospital Cardiac Arrest Care and Discovering Keys to Super-Survivorship

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2021 · —

## Abstract

Project Background: Since at least VHA Directive 2008-063, improving in-hospital cardiac arrest (IHCA) care
has been an important VA priority. This focus was renewed after the Office of the Inspector General report on
IHCA in 2013 (13-00054-148), and repeated again in 2015 with the formation of VHA Resuscitation Quality
Improvement Committee (RQI-C) by Assistant Deputy Undersecretary for Health for Clinical Operations. At the
individual level, vast amounts of VA clinician time are devoted to having every clinician recertify their Basic or
Advanced Cardiac Life Support training every two years to improve the care of IHCA. Our previous ResCU-1
project identified critical gaps in VA care of IHCA: (1) documentation of key IHCA factors that help systems
drive quality improvement, and clinicians determine prognosis and treatment after IHCA were often
unavailable; (2) 1/3rd to 2/3rd of VA hospitals underutilized other best practices in IHCA care, e.g. mock codes
and post-IHCA debriefing. Yet, ResCU-1 also found (3) some Veterans had remarkable recovery from IHCA,
becoming “super-survivors”—but we do not know how the care of super-survivors differed.
Specific Aims: Building on ResCU-1's foundations and in partnership with the VA Resuscitation Education
Initiative (REdI), we will: A1. Assess implementation of a new documentation template as a model for
quality efforts. A2. Develop & pilot new interventions to improve IHCA care, focusing on post-code
debriefing, mock code simulation training, and code documentation. A3. Identify IHCA super-survivors &
`best practices' associated with their care.
Project Methods: Aim 1 will be accomplished by retrospective review of all IHCA hospitalizations'
electronic medical records, research-assistant annotation of those records, and multi-level statistical
modeling. Aim 2 will use video-site-visits to identify barriers and facilitators using established frameworks
(CFIR and TDF), and then partner to pilot and implement interventions (likely beginning with virtual learning
collaborative) to improve documentation, mock codes, and post-IHCA debriefing. Aim 3 will do deep semi-
structured interviews with super-survivors, their informal caregivers and control patients of similar disability
who did not recover after IHCA, and their VA clinicians to identify candidate practices that may contribute to
super-survivorship. The association of those practices with super-survivorship will then be tested in a
prospective cohort of IHCA survivors. All will be integrated to produce and disseminate with partners a
`Code Blue Survivor Bundle' to form the basis of further improvements in VA care of IHCA.
Anticipated Impact on Veteran's Healthcare: An in-hospital cardiac arrest occurs when a patient's heart
stops beating effectively, either due to electrical or muscular problems. IHCA is a medical emergency; VA
devotes great resources to responding to IHCAs. In VA HSR&D's ResCU-1 study, we discovered that
important improvements can be mad...

## Key facts

- **NIH application ID:** 9796058
- **Project number:** 5I01HX002390-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Theodore J Iwashyna
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-10-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9796058

## Citation

> US National Institutes of Health, RePORTER application 9796058, ResCU II: Improving In-hospital Cardiac Arrest Care and Discovering Keys to Super-Survivorship (5I01HX002390-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9796058. Licensed CC0.

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