ODDS for survival after an in-hospital cardiac arrest decline from 22% after 1 minute of cardiopulmonary resuscitation (CPR), to less than 1% after 39 minutes, according to new research from University of Pittsburgh School of Medicine, Pennsylvania, USA.
“When patients do not achieve return of spontaneous circulation despite cardiopulmonary resuscitation, clinical providers face challenges in deciding how long to continue cardiopulmonary resuscitation,” stated Masashi Okubo, University of Pittsburgh School of Medicine. With in-hospital cardiac arrest becoming a growing public health concern, Okubo and colleagues conducted an observational study to determine outcome probabilities for patients following longer resuscitation times.
Data was analysed from 348,996 adults who experienced in-hospital cardiac arrest, and received CPR from 2000–2021 using the Get With the Guidelines-Resuscitation (GWTG-R) registry. The primary outcomes, survival to hospital discharge, and favourable functioning to hospital discharge, were determined using the cerebral performance category score of 1 (good cerebral performance), or 2 (moderate cerebral disability). CPR duration was defined as the interval between the start of chest compressions and the first return of spontaneous circulation, or termination of resuscitation.
Of the total 348,996 patients involved, 233,551 (66.9%) achieved a return of spontaneous circulation, and 22.6% survived to hospital discharge. The median interval between the start of chest compressions and the first return of spontaneous circulation was 7 minutes. For those that did not have return of spontaneous circulation, the median interval between the start of chest compressions and termination of resuscitation was 20 minutes.
Regarding the primary outcomes, both survival and favourable functional outcome probabilities decreased over time; <1% for survival after 39 minutes of CPR, and <1% for favourable functional outcome after 32 minutes of CPR. Okubo emphasised the significance of this study, explaining it provides healthcare professionals with clarity on when to terminate cardiopulmonary resuscitation.
