Abstract Body: Introduction:
In the United States, In-Hospital Cardiac Arrest occurs approximately 292,000 times annually with high variability in survival. Code review programs allow insight into performance where key metrics such as compression rate can be evaluated, then compared to benchmarks. The AHA recommends a compression rate of 100-120 compressions per minute (cpm).

Hypothesis:
The team hypothesized that compression rate compliance is associated with improved ROSC and survival to discharge in IHCA cases.

Method:
In 2024, a multisite observational study was conducted using an internal resuscitation registry which included 513 adult cardiac arrests across 14 hospitals. Chest compression rate was collected in 60-sec intervals resulting in 7,271 minutes of CPR. Cases were categorized by outcome: achieved ROSC, survival to discharge, or deceased. Outcome groups were evaluated for compression rate performance compliance.
Compliant – 80% within compression rate range
Non-compliant – < 33.3% compliant to rate range (calculated 1^st quartile)

Results:
ROSC was more frequently achieved at compression rates slightly above the AHA recommended range (figure1). Specifically, 70% of ROSC compression minutes are found within 104-126 cpm (mean ~116). This custom range captured a significantly higher proportion of ROSC minutes compared to the standard range (69.65% vs. 63.16%, p<0.05, CI 95%) and encompassed more cases that survived to discharge (p<0.05) (figure 2). Compliance with both the AHA recommended and custom range was significantly associated with ROSC (p<0.05). Distribution for ROSC vs non-ROSC cases had a significant overlap and highlighted differences in the frequency across compression rates (figure 3). Non-ROSC cases had higher average compression rates and greater variability, while ROSC cases had a tighter interquartile range centered around 116 cpm (p<0.05). ROSC frequency declined with rates exceeding 1 Standard Deviation above the mean.

Conclusions:
This study shows an association between high-quality compression rate adherence and higher ROSC and survival to discharge after IHCA. Findings suggest a slight upward adjustment to the recommended compression rate range may enhance ROSC and survival to discharge. By incorporating data from both academic and community hospitals, this study adds valuable insight to an under-researched area. Future research should explore additional chest compression performance metric assessments and impact on clinical outcomes.