CME - 2590


Longer resuscitation pays when heart arrest occurs in hospital

How long should revival efforts continue in patients who experience cardiac arrest in hospital? To answer this question, an observational study looked at the records of 64 339 patients with cardiac arrest in 435 US hospitals. People with pacemakers and those whose arrest occurred in emergency, surgery, procedure, or rehabilitation departments were excluded.

The researchers first looked at how hospitals varied in the duration of resuscitation attempts for people who died. Efforts lasted less than 10 minutes for 15.8% of these patients and up to 30 minutes in 76.6%. The median duration of resuscitation in the quarter of hospitals with the shortest times was 16 minutes (interquartile range 15 - 17), followed by 19 (18 - 20), 22 (21 - 23), and 25 (25 - 28) minutes.

Survivors were most common in the last group. People who were treated for the longest time were 12% more likely to have a pulse restored for at least 20 minutes (95% CI 6 - 18%) and 12% more likely to survive to discharge (2 - 23%) than those treated for the shortest time. Patients without systolic activity or a pulse were least likely to survive to discharge, but they also benefited most from longer revival efforts (adjusted risk ratio for longest versus shortest quarter 1.20, 95% CI 1.05 - 1.36). However, no difference was seen between the groups of hospitals in the proportion of patients who were discharged without major neurological impairments (adjusted risk ratio for longest versus shortest quarter 1.00, 0.95 - 1.06).

Longer revival efforts could be a marker of better care overall, but it might be a good idea to set a minimum length for revival efforts. For now, teams might try to prolong resuscitation efforts by 10 - 15 minutes, suggest the authors.

Goldberg ZD, et al. Lancet 2012. []

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