Following In-Hospital Cardiac Arrest, How Long Can CPR Be Performed with Probable Favorable Outcomes?
BACKGROUND AND PURPOSE:
- When patients do not spontaneously regain circulation, it is unclear how long cardiopulmonary resuscitation (CPR) should be continued
- Okubo et al. (BMJ, 2024) quantified time dependent probabilities of outcomes in patients after in-hospital cardiac arrest as a function of duration of CPR
METHODS:
- Retrospective cohort study
- Get With The Guidelines—Resuscitation (GWTG-R) registry, a multicenter prospective quality improvement registry of in-hospital cardiac arrest in the US
- Population
- Adult patients
- Index in-hospital cardiac arrest
- Received CPR from 2000 through 2021
- Exposures
- Duration of CPR
- Interval between the start of chest compressions and the first return of spontaneous circulation or termination of resuscitation
- Duration of CPR
- Study design
- Time dependent probabilities of the primary outcomes as a function of duration of CPR were calculated
- Primary outcome
- Survival to hospital discharge
- Favorably functional outcome at hospital discharge
- Defined as a cerebral performance category score of 1 (good cerebral performance) or 2 (moderate cerebral disability)
RESULTS:
- 348,996 patients
- Achieved return of spontaneous circulation: 66.9%
- Median duration of CPR: 7 (IQR, 3 to 13) minutes
- Did not achieve return of spontaneous circulation: 33.1%
- Median duration of CPR: 20 (IQR, 14 to 30) minutes
- Achieved return of spontaneous circulation: 66.9%
- Patients who survived to hospital discharge: 22.6%
- At one minute of CPR, the time dependent probability of the following outcomes, pending return of spontaneous circulation was
- For survival: 22.0%
- For favorable functional outcome: 15.1%
- The probabilities dipped below 1% for survival and a favorable functional outcome by
- Survival: 39 minutes of CPR
- Favorable functional outcome: 32 minutes of CPR
CONCLUSION:
- The probability of survival or a favorable functional outcome for patients who experience in-hospital cardiac arrest and CPR drop below 1% after approximately 35 minutes
- The authors state
The findings provide resuscitation teams, patients, and their surrogates with the objective probabilities of subsequent favorable outcomes if patients pending the first return of spontaneous circulation received further cardiopulmonary resuscitation
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