Yale Study Finds New Clue in Cardiac Arrest Survival Gap

When patients survive a cardiac arrest in the hospital, Black and Hispanic patients are less likely than white patients to make it home alive. Yale researchers just crossed one suspected reason off the list, bringing medicine closer to real answers.

The study examined nearly 300,000 in-hospital cardiac arrests across 350 U.S. hospitals between 2018 and 2023. Researchers wanted to know if early do-not-attempt-resuscitation orders (DNARs) might explain why survival rates differ by race and ethnicity.

Here's what they found: Black, Hispanic, and American Indian or Alaska Native patients were actually less likely to have DNAR orders placed within 72 hours after their hearts restarted. About one in four white patients had these orders within 12 hours, compared to fewer patients of color.

But among those who did have early DNAR orders, survival rates were similar across all racial and ethnic groups. That tells researchers this particular factor isn't driving the disparity.

"We already know there are persistent racial and ethnic differences in survival after in-hospital cardiac arrest," said Caroline Raymond-King, an emergency medicine resident at Yale School of Medicine. The team wanted to know if DNAR timing could be one contributor to survival gaps after resuscitation.

The answer turned out to be no, but that's actually progress. By ruling out what doesn't cause the problem, researchers can focus their energy on finding what does.

The Bright Side

This study does more than eliminate a false lead. It reveals an important practice pattern that affects patient care nationwide.

Early DNAR orders happen frequently in American hospitals: one in three white patients within 72 hours of cardiac arrest. The timing and framing of these conversations with families matter enormously, and they're happening right when emotions run highest.

The findings also show that differences in medical decision-making do exist by race and ethnicity, even if they don't explain survival gaps. Understanding these patterns helps doctors have better, more equitable conversations with all families during critical moments.

"We still have work to do to understand how to mitigate the survival gap for non-white patients after cardiac arrest," Raymond-King said. But now researchers know where not to look, which means they can redirect their efforts toward solutions that will actually work.

Senior author Sarah Perman, an associate professor of emergency medicine at Yale, sees the silver lining clearly. Researchers can now appreciate that early DNAR timing isn't the immediate target to fix, allowing them to investigate other factors that might truly reduce disparities in cardiac arrest outcomes.

Every eliminated hypothesis brings medicine one step closer to saving more lives equally.