China's first large cardiac-arrest registry: 9% survive to leave hospital

When a patient's heart stops while they are already in a hospital bed, help should be seconds away. A new registry — the largest contemporary look at in-hospital cardiac arrest in China — shows how far that advantage can fall short of a good outcome. Across 37 hospitals, resuscitation almost always began within a minute, yet fewer than one in ten patients lived to leave the hospital [s1].

In-hospital cardiac arrest is distinct from the collapses that happen in the street. The patient is surrounded by staff, monitors and crash carts, so the chain of survival should be at its strongest. Rich countries have slowly pushed survival up through structured response teams and better after-care, but comparable multi-centre data from low- and middle-income settings have been scarce, leaving a gap in the global picture [s1].

What the study did

The BASIC-IHCA registry (Baseline Investigation of In-Hospital Cardiac Arrest) enrolled adults aged 18 or older who had cardiopulmonary resuscitation for a cardiac arrest while admitted, between 1 July 2019 and 31 December 2020, at 37 hospitals spread across 29 provinces [s1]. In all, 17,602 patients were included; the median age was 66 and 65.5% were male [s1]. This is an observational cohort, not a trial of any treatment — its value is in benchmarking how the system performs. The companion registry entry lists it as an observational study begun in 2019 [s2].

The primary outcome was survival to 30 days or hospital discharge. The investigators also tracked return of spontaneous circulation, survival at 6 and 12 months, neurological recovery (measured on the Cerebral Performance Category scale, where 1-2 counts as favourable), and process measures such as how fast resuscitation started and whether after-care was delivered [s1].

What it found

The front end of the response looked strong. The annual incidence of adult in-hospital cardiac arrest was 4.1 per 1,000 admissions [s1]. Cardiac causes accounted for 6,569 patients (37.3%), and 2,380 (13.5%) had an initial shockable rhythm — the kind most likely to respond to a defibrillator [s1]. Chest compressions began within one minute in 16,872 patients (95.9%) [s1]. Timely defibrillation reached 71.4% of those with a shockable rhythm, and timely adrenaline 84.4% of those with a non-shockable rhythm [s1].

Then the numbers fell away. Sustained return of circulation was achieved in 6,200 patients (35.2%) [s1]. Among those, only 222 (3.6%) received temperature-control therapy and 320 (5.2%) underwent coronary angiography — two cornerstones of modern after-arrest care [s1]. Ultimately 1,610 patients (9.1%) survived to 30 days or discharge, and 1,241 (7.1%) left with a favourable neurological outcome [s1]. By 12 months, 1,075 (6.1%) were still alive and 986 (5.6%) had a favourable neurological outcome [s1].

How to read it

The gap between a fast start and a poor finish is the story. Getting compressions going within a minute in 96% of cases is genuinely good; the losses accumulate afterwards, where only a small fraction of patients whose circulation was restored went on to receive the temperature management or coronary assessment that can protect the brain and heart in the hours that follow [s1]. The authors frame this as a system problem — gaps in post-resuscitation care, uneven critical-care resources, and cultural factors including the infrequent use of do-not-attempt-resuscitation orders, which can mean CPR is attempted in patients unlikely to benefit [s1].

A single-country registry does not transfer wholesale to other health systems, and a 9% survival figure should be read against that country's specific case mix and care pathways rather than as a verdict on any one hospital [s1]. But the shape of the finding — a strong immediate response undercut by thinner after-care — is a pattern worth examining anywhere. For related coverage, see a trial of sodium bicarbonate during in-hospital arrest, how much oxygen to give after cardiac arrest, and a registry of sudden cardiac arrests among marathon runners.

What to watch

The registry is explicitly a baseline. Its purpose is to mark where the system stands so that targeted fixes — structured response systems, better allocation of intensive-care resources, and earlier conversations about goals of care — can be tested against it [s1]. The measure of its worth will be whether the next cohort does better.

This article describes observational research and is not medical advice.

Sources

• Incidence, Process of Care, and Outcomes of In-Hospital Cardiac Arrest in China — Circulation, 6 October 2026
• Baseline Investigation of Patients With Cardiac Arrest in China (NCT03926325) — ClinicalTrials.gov