Try resuscitating a little longer, say researchers

Sep 11 2012

By Piriya Mahendra, medwireNews Reporter

Researchers report in The Lancet that the duration of resuscitation attempts varies widely between hospitals and increasing it could improve survival in patients with cardiac arrest.

Compared with patients at hospitals in the lowest quartile for median resuscitation duration (16 minutes), those at hospitals in the highest quartile (median duration 25 minutes) had a significant 12% higher likelihood for achieving return of spontaneous circulation and survival to discharge.

The median duration of resuscitation was 12 minutes for patients who achieved return of spontaneous circulation after experiencing cardiac arrest and 20 minutes for nonsurvivors, Brahmajee Nallamothu (University of Michigan, Ann Arbor, USA) and team note.

There was no significant association between neurologic status and median duration of resuscitation, somewhat contradicting the belief held by many clinicians that patients who are resuscitated for longer have a poor prognosis, say the team.

The study involved 64,339 cardiac patients across 435 US hospitals in the Get With the Guidelines-Resuscitation registry between 2000 and 2008.

In a press statement, co-author Zachary Goldberger said it is not surprising that a wide variation exists among hospitals' average length of resuscitation attempts, given there is no firm evidence to guide practitioners as to when to stop their efforts once resuscitation has started.

"Our findings suggest an opportunity for improving care in this high-risk population," he said. "Overall, it may involve standardizing the time required for continuing resuscitation attempts prior to decisions regarding termination of efforts."

While the study findings imply that clinicians should increase resuscitation times, Nallamothu cautioned: "We want to emphasize that our findings cannot identify an optimal duration for which to resuscitate patients."

Another co-author, Steven Kronick, also from the University of Michigan, agreed, saying, "The optimal resuscitation duration for any individual patient will continue to remain a bedside decision that relies on careful clinical judgment.

"Overall, we believe these findings present an opportunity to improve resuscitation care, especially at a systems-level."

Editorialists Jerry Nolan (Royal United NHS Trust, Bristol, UK) and Jasmeet Soar (Southmead Hospital, Bristol, UK) conclude: "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."

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