Study Suggests Increasing Duration of Resuscitation Might Improve Survival among Patients Suffering Cardiac Arrest
Little empirical evidence is available to guide clinicians about the appropriate length of resuscitation attempts before termination of efforts during cardiac arrest. This observational study examined whether duration of resuscitation attempts varies between hospitals, and whether patients at hospitals that attempt longer resuscitations have higher survival rates than those at hospitals with shorter durations of resuscitation efforts. Using the Get With The Guidelines — Resuscitation registry, investigators identified 64,339 patients who experienced a cardiac arrest at one of 435 U.S. hospitals between 1/1/00 and 8/26/08. Primary measures were immediate survival with return of spontaneous circulation during cardiac arrest, and survival to hospital discharge. For patients who survived until discharge, neurological status was classified into five groups: no major disability, moderate disability, severe disability, coma or vegetative state, and brain death.
- Despite several advances in resuscitation care, overall survival after in-hospital cardiac arrest remains poor. Of the 64,339 patients in this study, 49% achieved return of spontaneous circulation, and 15% survived to discharge.
- Patients who had cardiac arrests at hospitals with longer median resuscitation durations had higher overall survival than did those who arrested in hospitals with shorter median durations. For example, compared with patients at hospitals with the shortest median resuscitation attempts in non-survivors (16 minutes), patients at hospitals with the longest attempts (25 minutes) had a higher likelihood of return to spontaneous circulation and survival to discharge.
- For patients achieving return of spontaneous circulation, the median duration of resuscitation was 12 minutes compared with 20 minutes for non-survivors.
- The likelihood of patients surviving to discharge with a favorable neurological status did not differ significantly between hospitals with shorter or longer resuscitation durations.
- Participating hospitals tended to be large, therefore results may not be generalizable.
- This study was observational, thus cannot show a causal relation between increasing the duration of resuscitation attempts and survival rates.
- In a â€˜Comment,' also in this issue of The Lancet, Drs. Nolan and Soar suggest that these findings reassure clinicians that prolonged resuscitation does not seem to result in a substantial increase in severe neurological injury to survivors. They also suggest that duration of resuscitation attempts be established on a case-by-case basis, taking into account other determinants of survival.
Drs. Hayward and Nallamothu are part of HSR&D's Center for Clinical Management Research, Ann Arbor, MI. Dr. Krumholz is part of VA/HSR&D's Ischemic Heart Disease Quality Enhancement Research Initiative.
Goldberger Z, Chan P, Berg R, Kronick S, Cooke C, Lu M, Banerjee M, Hayward R, Krumholz H, and Nallamothu B for the American Heart Association Get With The Guidelines-Resuscitation investigators. Duration of Resuscitation Efforts and Survival after In-Hospital Cardiac Arrest: An Observational Study. The Lancet September 5, 2012;Epub ahead of print.