At hospitals severely affected by the novel coronavirus disease 2019 (COVID-19) pandemic, challenges were encountered in resuscitation care that raised questions concerning the effect of the pandemic on outcomes for in-hospital cardiac arrest throughout the United States. A retrospective cohort study was performed within Get With The Guidelines–Resuscitation, with the aim to compare in-hospital cardiac arrest survival during the presurge (January 1–February 29), surge (March 1–May 15) and immediate postsurge (May 16–June 30) periods in 2020 compared with 2015 to 2019.

• A total of 61,586 in-hospital cardiac arrests were assessed; of these, the presurge, surge, and postsurge periods had occurrences of 212,08 (4,309 in 2020), 26,459 (5,949 in 2020), and 13,919 (2,686 in 2020) cardiac arrests, respectively.

• There was a decrease in rates of survival to discharge for IHCA early during the pandemic, even among patients without COVID-19 infection, highlighting the early impact of the COVID-19 pandemic on in-hospital resuscitation.

• Communities with high (28% lower survival) and very high (42% lower survival) monthly COVID-19 mortality rates had most pronounced lower survival.

• During the surge period, there were shorter resuscitation times, and greater prevalence of delayed epinephrine treatment.