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Duration of Resuscitation Efforts and Survival After In-Hospital Cardiac Arrest: An Observational Study
Study Questions:
What is the impact of duration of resuscitation attempts on survival rates?
Methods:
Between 2000 and 2008, the investigators identified 64,339 patients with cardiac arrests at 435 US hospitals within the Get With The Guidelines—Resuscitation registry. For each hospital, they calculated the median duration of resuscitation before termination of efforts in nonsurvivors as a measure of the hospital’s overall tendency for longer attempts. The authors used multilevel regression models to assess the association between the length of resuscitation attempts and risk-adjusted survival. The primary endpoints were immediate survival with return of spontaneous circulation during cardiac arrest and survival to hospital discharge.
Results:
A total of 31,198 of 64,339 (48.5%) patients achieved return of spontaneous circulation, and 9,912 (15.4%) survived to discharge. For patients achieving return of spontaneous circulation, the median duration of resuscitation was 12 minutes (interquartile range [IQR], 6-21) compared with 20 minutes (14-30) for nonsurvivors. Compared with patients at hospitals in the quartile with the shortest median resuscitation attempts in nonsurvivors (16 minutes [IQR, 15-17]), those at hospitals in the quartile with the longest attempts (25 minutes [25-28]) had a higher likelihood of return of spontaneous circulation (adjusted risk ratio, 1.12; 95% confidence interval, 1.06-1.18; p < 0.0001) and survival to discharge (1.12, 1.02-1.23; 0.021).
Conclusions:
The authors concluded that efforts to systematically increase the duration of resuscitation could improve survival in this high-risk population.
Perspective:
This study reports substantial variation between hospitals in the duration of resuscitation attempts in nonsurvivors. Furthermore, patients at hospitals in which the median duration of resuscitation attempts was longer had a higher likelihood of return of spontaneous circulation and survival to discharge than did those at hospitals with shorter median resuscitation durations. The study does not define an optimum duration for resuscitation attempts, but it appears that efforts to systematically increase the duration of resuscitation efforts may improve survival in this high-risk population. Additional research is indicated to define optimal duration for resuscitation attempts that would improve survival while avoiding futile use of resources.
Keywords: Hospitals, Cardiopulmonary Resuscitation, Heart Arrest, Patient Discharge
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