{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:04:26Z","timestamp":1790179466267,"version":"4.1.0"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Health care crises may be associated with changes in in-hospital cardiac arrest (IHCA) care and resuscitation practices. Whether prolonged health care workforce shortage is associated with termination of resuscitation (TOR) practices remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether a nationwide resident resignation in South Korea was associated with differences in IHCA characteristics, resuscitation trajectories, and TOR practices.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A retrospective cohort study conducted at a single tertiary teaching hospital in South Korea of adults aged 18 years or older who underwent cardiopulmonary resuscitation (CPR) for IHCA between March 1, 2023, and February 28, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n IHCA occurring before vs during a workforce crisis precipitated by mass resident physician resignations.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were return of spontaneous circulation (ROSC) and TOR without ROSC, analyzed as competing events over CPR duration. Secondary outcomes included CPR duration, 24-hour survival, 30-day survival, favorable neurological status, and survival to discharge.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 383 patients with 469 IHCA events were included (median [IQR] age, 69 [61-79] years; 238 [62.1%] male). Overall IHCA incidence did not differ between periods (2.30 vs 2.50 incidents per 1000 admissions;\n P<\/jats:italic>\n \u2009=\u2009.36). The median CPR duration was 8 minutes in both periods. CPR exceeding 35 minutes was less frequent during vs before the crisis (12 of 180 events [6.7%] vs 38 of 289 events [13.1%];\n P<\/jats:italic>\n \u2009=\u2009.03). ROSC, neurological outcomes, and survival outcomes did not differ statistically. In adjusted competing-risk analyses, the crisis period was not associated with ROSC (adjusted hazard ratio [aHR], 0.93; 95% CI, 0.72-1.19) but was associated with higher hazard of TOR without ROSC (aHR, 1.66; 95% CI, 1.14-2.42). Standardized cumulative incidence analyses showed a higher cumulative incidence of TOR without ROSC, with an absolute risk difference of 4.9 percentage points at 35 minutes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this retrospective cohort study, the crisis period was associated with fewer prolonged CPR attempts, with no significant differences in ROSC or survival outcomes. These findings suggest that prolonged health care workforce shortage and associated resuscitation-system adaptations may have influenced TOR practices, underscoring the need for standardized TOR decision-making.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.35568","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:30:29Z","timestamp":1790177429000},"page":"e2635568","source":"Crossref","is-referenced-by-count":0,"title":["In-Hospital Cardiac Resuscitation During Widespread Resident Resignations in South Korea"],"prefix":"10.1001","volume":"9","author":[{"given":"Donghyeong","family":"Koo","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulhee","family":"Kim","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Jun","family":"Park","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoon Hae","family":"Ahn","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-Eui","family":"Lee","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si Mong","family":"Yoon","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choon Geun","family":"Lee","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Yeul","family":"Lee","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joo Hae","family":"Kim","sequence":"additional","affiliation":[{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Min","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinwoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea"},{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Rapid Response Team, Seoul National University Hospital, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"12","key":"zoi260958r1","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1001\/jama.2019.1696","article-title":"In-hospital cardiac arrest: a review.","volume":"321","author":"Andersen","year":"2019","journal-title":"JAMA"},{"issue":"16_suppl_2","key":"zoi260958r2","doi-asserted-by":"publisher","first-page":"S353","DOI":"10.1161\/CIR.0000000000001378","article-title":"Part 4: systems of care: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.","volume":"152","author":"Dezfulian","year":"2025","journal-title":"Circulation"},{"key":"zoi260958r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2023.109996","article-title":"Ten steps toward improving in-hospital cardiac arrest quality of care and outcomes.","volume":"193","author":"Chan","year":"2023","journal-title":"Resuscitation"},{"issue":"1","key":"zoi260958r4","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s40560-021-00570-8","article-title":"Effect of the COVID-19 pandemic on cardiac arrest resuscitation practices and outcomes in non-COVID-19 patients.","volume":"9","author":"Tong","year":"2021","journal-title":"J Intensive Care"},{"key":"zoi260958r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.resplu.2022.100317","article-title":"Early changes in hospital resuscitation practices during the COVID-19 pandemic.","volume":"12","author":"Secrest","year":"2022","journal-title":"Resusc Plus"},{"key":"zoi260958r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.resplu.2024.100756","article-title":"The impact of the SARS-CoV-2 pandemic on in-hospital cardiac arrest: A systematic review and meta-analysis.","volume":"20","author":"Fekete-Gyor","year":"2024","journal-title":"Resusc Plus"},{"key":"zoi260958r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2024.110172","article-title":"Impact of a COVID-19 code blue protocol on resuscitation care and CPR quality during in-hospital cardiac arrest.","volume":"198","author":"Vaillancourt","year":"2024","journal-title":"Resuscitation"},{"issue":"2","key":"zoi260958r8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.121.008420","article-title":"In-hospital cardiac arrest survival in the United States during and after the initial novel coronavirus disease 2019 pandemic surge.","volume":"15","author":"Chan","year":"2022","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"zoi260958r9","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110734","article-title":"European Resuscitation Council guidelines 2025 ethics in resuscitation.","volume":"215","author":"Raffay","year":"2025","journal-title":"Resuscitation"},{"issue":"3","key":"zoi260958r10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0213168","article-title":"Factors associated with the decision to terminate resuscitation early for adult in-hospital cardiac arrest: Influence of family in an East Asian society.","volume":"14","author":"Wang","year":"2019","journal-title":"PLoS One"},{"issue":"10444","key":"zoi260958r11","doi-asserted-by":"publisher","first-page":"2589","DOI":"10.1016\/S0140-6736(24)00766-9","article-title":"The South Korean health-care system in crisis.","volume":"403","author":"Yoon","year":"2024","journal-title":"Lancet"},{"key":"zoi260958r12","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2024.101056","article-title":"The Lancet Regional Health-Western Pacific. junior doctor strikes in South Korea: more doctors are needed?","volume":"44","year":"2024","journal-title":"Lancet Reg Health West Pac"},{"issue":"12","key":"zoi260958r13","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2026.41.e102","article-title":"Burnout and depression of medical faculty: after mass resignation of junior doctors in Korea.","volume":"41","author":"Seong","year":"2026","journal-title":"J Korean Med Sci"},{"key":"zoi260958r14","doi-asserted-by":"publisher","first-page":"r1876","DOI":"10.1136\/bmj.r1876","article-title":"South Korean doctors end 18 month strike.","volume":"390","author":"Murphy","year":"2025","journal-title":"BMJ"},{"key":"zoi260958r15","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1718795","article-title":"The association of nationwide trainee doctor mass resignations in South Korea with hospital utilization, expenditure, and patient outcomes.","volume":"13","author":"Kim","year":"2025","journal-title":"Front Public Health"},{"issue":"3","key":"zoi260958r16","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2026.0697","article-title":"Resident physician walkout and high-incidence cancer operation volumes in South Korea.","volume":"9","author":"Son","year":"2026","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi260958r17","doi-asserted-by":"publisher","first-page":"393","DOI":"10.4266\/acc.000575","article-title":"Impact of medical crisis on the critical care system in South Korea.","volume":"40","author":"Chang","year":"2025","journal-title":"Acute Crit Care"},{"issue":"5","key":"zoi260958r18","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"6","key":"zoi260958r19","doi-asserted-by":"publisher","first-page":"509","DOI":"10.7861\/clinmed.2022-0435","article-title":"Using NEWS2: an essential component of reliable clinical assessment.","volume":"22","author":"Welch","year":"2022","journal-title":"Clin Med (Lond)"},{"issue":"18","key":"zoi260958r20","doi-asserted-by":"publisher","first-page":"e746","DOI":"10.1161\/CIR.0000000000000710","article-title":"Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry template for in-hospital cardiac arrest: a consensus report from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia).","volume":"140","author":"Nolan","year":"2019","journal-title":"Circulation"},{"key":"zoi260958r21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-076019","article-title":"Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study.","volume":"384","author":"Okubo","year":"2024","journal-title":"BMJ"},{"issue":"9852","key":"zoi260958r22","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1016\/S0140-6736(12)60862-9","article-title":"Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study.","volume":"380","author":"Goldberger","year":"2012","journal-title":"Lancet"},{"issue":"16_suppl_2","key":"zoi260958r23","doi-asserted-by":"publisher","first-page":"S538","DOI":"10.1161\/CIR.0000000000001376","article-title":"Part 9: Adult advanced life support: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.","volume":"152","author":"Wigginton","year":"2025","journal-title":"Circulation"},{"key":"zoi260958r24","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.resuscitation.2022.08.011","article-title":"Duration of resuscitation and long-term outcome after in-hospital cardiac arrest: A nationwide observational study.","volume":"179","author":"Yonis","year":"2022","journal-title":"Resuscitation"},{"key":"zoi260958r25","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/7384649","article-title":"Review and outcome of prolonged cardiopulmonary resuscitation.","volume":"2016","author":"Youness","year":"2016","journal-title":"Crit Care Res Pract"},{"issue":"1","key":"zoi260958r26","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s13054-022-03994-2","article-title":"Cardiopulmonary resuscitation duration and favorable neurological outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry).","volume":"26","author":"Matsuyama","year":"2022","journal-title":"Crit Care"},{"issue":"3","key":"zoi260958r27","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002819","article-title":"Relationship between the duration of cardiopulmonary resuscitation and favorable neurological outcomes after out-of-hospital cardiac arrest: a prospective, nationwide, population-based cohort study.","volume":"5","author":"Goto","year":"2016","journal-title":"J Am Heart Assoc"},{"key":"zoi260958r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2026.111028","article-title":"Duration of emergency medical services-initiated prehospital cardiopulmonary resuscitation efforts and survival for pediatric patients with out-of-hospital cardiac arrest.","volume":"223","author":"Okubo","year":"2026","journal-title":"Resuscitation"},{"issue":"4","key":"zoi260958r29","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1001\/jamainternmed.2024.7814","article-title":"Termination of resuscitation rules for in-hospital cardiac arrest.","volume":"185","author":"Holmberg","year":"2025","journal-title":"JAMA Intern Med"},{"issue":"11","key":"zoi260958r30","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.007303","article-title":"Characteristics and outcomes of in-hospital cardiac arrest events during the COVID-19 pandemic: a single-center experience from a New York City public hospital.","volume":"13","author":"Miles","year":"2020","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"11","key":"zoi260958r31","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1093\/eurheartj\/ehaa1067","article-title":"Cardiac arrest in COVID-19: characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation.","volume":"42","author":"Sultanian","year":"2021","journal-title":"Eur Heart J"},{"key":"zoi260958r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2026.106225","article-title":"Impact of mass resident physician resignation on inpatient mortality and admissions in Korea.","volume":"254","author":"Choi","year":"2026","journal-title":"Public Health"},{"key":"zoi260958r33","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.resuscitation.2020.06.001","article-title":"European Resuscitation Council COVID-19 guidelines executive summary.","volume":"153","author":"Nolan","year":"2020","journal-title":"Resuscitation"},{"key":"zoi260958r34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2147\/OAEM.S183248","article-title":"Decision-making in cardiac arrest: physicians\u2019 and nurses\u2019 knowledge and views on terminating resuscitation.","volume":"11","author":"Hansen","year":"2018","journal-title":"Open Access Emerg Med"},{"issue":"3","key":"zoi260958r35","doi-asserted-by":"publisher","first-page":"183","DOI":"10.12809\/hkmj187755","article-title":"Questionnaire survey on medical futility and termination of resuscitation in cardiac arrest patients among emergency physicians in Hong Kong.","volume":"25","author":"So","year":"2019","journal-title":"Hong Kong Med J"},{"key":"zoi260958r36","doi-asserted-by":"publisher","first-page":"146","DOI":"10.4274\/eajem.galenos.2023.69320","article-title":"Questionnaire survey medical futility and termination of resuscitation in out-of-hospital-cardiac-arrest patients presenting to emergency department in hospitals in Klang Valley.","volume":"22","author":"Salleh","year":"2023","journal-title":"Eurasian Journal of Emergency Medicine"},{"issue":"6","key":"zoi260958r37","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1007\/s00134-016-4240-8","article-title":"Effect of ICU strain on timing of limitations in life-sustaining therapy and on death.","volume":"42","author":"Hua","year":"2016","journal-title":"Intensive Care Med"},{"key":"zoi260958r38","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.resuscitation.2015.01.014","article-title":"Organisation of in-hospital cardiac arrest teams - a nationwide study.","volume":"89","author":"Lauridsen","year":"2015","journal-title":"Resuscitation"},{"issue":"6","key":"zoi260958r39","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1016\/j.mayocpiqo.2021.06.002","article-title":"Association between hospital resuscitation team leader credentials and survival outcomes for in-hospital cardiac arrest.","volume":"5","author":"Hejjaji","year":"2021","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"issue":"8","key":"zoi260958r40","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000031","article-title":"Rapid response and cardiac arrest teams: a descriptive analysis of 103 American hospitals.","volume":"1","author":"Mitchell","year":"2019","journal-title":"Crit Care Explor"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2854377\/koo_2026_oi_260958_1789497783.0481.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:30:30Z","timestamp":1790177430000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2854377"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.35568","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]}}}