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Duration of resuscitation attempts varies between US hospitals
New research suggests that increasing the duration of resuscitation efforts could improve survival after in-hospital cardiac arrest.
“Our findings suggest that prolonging resuscitation efforts by 10 or 15 minutes might improve outcomes. The good news is that such an approach might have only modest effects on neurological outcomes and resource use once efforts have already began,” researcher Zachary D. Goldberger, MD, of University of Washington, said in a press release.
Researchers used data from the American Heart Association’s Get With The Guidelines–Resuscitation registry to examine whether the length of resuscitation efforts varied between hospitals and the survival rates at hospitals that attempted longer vs. shorter resuscitation efforts.
The study included 64,339 patients from 435 US hospitals who underwent resuscitation for a cardiac arrest between 2000 and 2008. Of those, 48.5% achieved return of spontaneous circulation and 15.4% survived to discharge.
Median duration of resuscitation was 12 minutes for patients who achieved return of spontaneous circulation compared with 20 minutes for nonsurvivors. Patients cared for at hospitals with the longest median resuscitation attempts (25 minutes) had a greater likelihood of return to spontaneous circulation (adjusted RR=1.12; 95% CI, 1.06-1.18) and survival to discharge (adjusted RR=1.12; 95% CI, 1.02-1.23) compared with patients at hospitals with the shortest median resuscitation attempts, according to the study abstract.
Hospitals were ranked by quartiles on the basis of median duration of resuscitation attempts in nonsurvivors: 16, 19, 22 and 25 minutes.
The researchers said the proportion of patients surviving to discharge with a favorable neurological status was similar regardless of resuscitation duration, according to the release.
“Although we cannot define an optimum duration for resuscitation attempts on the basis of these observational data, our findings suggest that efforts to systematically increase the duration of resuscitation could improve survival in this high-risk population,” Goldberger and colleagues concluded in the study.
Jerry P. Nolan, MBChB, of the Royal United Hospital NHS Trust in Bath, United Kingdom, and Jasmeet Soar, MBBChir, of Southmead Hospital in Bristol, United Kingdom, wrote in a linked comment: “[This] study reassures clinicians that prolonged resuscitation attempts do not seem to result in a substantial increase in severe neurological injury in survivors. To improve outcomes, all hospitals should audit their cardiac arrests and benchmark outcomes as part of a quality improvement program. … Prolonged resuscitation efforts can result in high-quality survival. If the cause of cardiac arrest is potentially reversible, it might be worthwhile to try for a little longer.”
For more information:
Goldberger ZD. Lancet. 2012;doi:10.1016/S0140-6736(12)60862-9.
Nolan JP. Lancet. 2012;doi:10.1016/S0140-6736(12)61182-9.
Disclosure: Goldberger reports no relevant financial disclosures. Nolan is editor in chief of Resuscitation (honorarium received). Soar is an editor of Resuscitation (honorarium received).