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Many hospitalized children survive after prolonged CPR

Issue: March 2013

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Once considered futile, cardiopulmonary resuscitation for 20 minutes or more in hospitalized children following cardiac arrest was associated with survival to discharge, according to new research.

Renée I. Matos, MD, MPH, from San Antonio Military Medical Center, and colleagues discovered that the probability of surviving a pediatric in-hospital cardiac arrest at 20 minutes of CPR was 26.6%.

 

Renée I. Matos

“This study dispels common misperceptions that CPR is futile beyond 20 minutes,” Matos said in a press release. “We believe that health care providers now will consider longer-duration CPR for some patients, and that a thoughtful approach to providing longer durations of CPR to some children will save more lives.”

On average, resuscitation time among surviving patients was 10 minutes, compared with 25 minutes among patients who died. Among 954 survivors studied, 36% had CPR for at least 15 minutes or more and 16.6% had CPR for more than 35 minutes.

Nineteen percent of all cardiac arrest patients had favorable neurologic outcomes. Among survivors, favorable neurologic outcomes occurred in 70% of patients who had less than 15 minutes of CPR and 60% who had more than 35 minutes of CPR.

Although many patients survived after prolonged cardiopulmonary resuscitation, shorter durations were associated with better overall outcomes. Within the first 15 minutes of CPR, the survival rate decreased by 2.1% per minute and continued to decrease the longer CPR was administered (survival rate at 1-5 minutes of CPR, 44.1%; 16 to 35 minutes, 17.8%; >35 minutes, 15.9%). In addition, rates of favorable neurologic outcome decreased by 1.2% per minute, according to the study abstract.

Also uncovered were outcomes of surgical cardiac patients. Surgical cardiac patients had the highest adjusted odds for survival and favorable neurologic outcomes, compared with general medical patients (OR=2.5; 95% CI, 1.8-3.4 and OR=2.7; 95% CI, 2-3.9). “Surgical cardiac patients had a better probability of survival after 90 minutes of chest compression than trauma patients had after 1 minute,” the researchers wrote.

The data come from a review of 3,419 pediatric in-hospital cardiac arrests at 328 American and Canadian hospitals. All hospitals participated in the American Heart Association’s Get With The Guidelines–Resuscitation program between 2000 and 2009. The mean age of the patients was 4.9 years.

“The probability of survival and favorable neurologic outcome decreases with each passing minute,” Matos stated in the release. “So while these results are supportive of doing CPR longer, it’s still critical that high-quality life support be started immediately.”

For more information:

Matos RI. Circulation. 2013;doi:10.1161/​CIRCULATIONAHA.112.125625.

Disclosure: Matos reports no relevant financial disclosures.