Survival with prolonged CPR better than expected

Short Attention Span Summary

Is it ever beneficial to do CPR longer than 10 minutes, as survival theoretically drops 10% per minute?  In this Danish study, an amazing 14% with CPR > 25 minutes survived at 30 days (18/19 able to live at home vs. nursing home).


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Abstract

Resuscitation. 2016 May 17. pii: S0300-9572(16)30057-0. doi: 10.1016/j.resuscitation.2016.05.004. [Epub ahead of print]

Prolonged Cardiopulmonary Resuscitation and Outcomes after Out-of-Hospital Cardiac Arrest.

Rajan S1, Folke F2, Kragholm K3, Hansen CM4, Granger CB5, Hansen SM6,Peterson ED5, Lippert FK7, Søndergaard KB4, Køber L8, Gislason GH9,Torp-Pedersen C6, Wissenberg M10.

Author information:

1Department of Cardiology, Copenhagen University Hospital Gentofte. Kildegårdvej 28, Post 635, 2900 Hellerup, Denmark. Electronic address:shahzleen@gmail.com.

2Department of Cardiology, Rigshospitalet, Copenhagen University Hospital. Blegdamsvej 9, 2100 Copenhagen, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen. Telegrafvej 5, 2750 Ballerup, Denmark.

3Cardiovascular Research Center, Department of Anesthesiology, Aalborg University Hospital. Sdr. Skovvej 15, 9000 Aalborg, Denmark.

4Department of Cardiology, Copenhagen University Hospital Gentofte. Kildegårdvej 28, Post 635, 2900 Hellerup, Denmark.

5Duke Clinical Research Institute. 2400 Pratt St, Durham, NC, USA.

6Department of Health, Science and Technology, Aalborg University. Niels Jernes Vej 12, 9220 Aalborg, Denmark.

7Emergency Medical Services Copenhagen, University of Copenhagen. Telegrafvej 5, 2750 Ballerup, Denmark.

8Department of Cardiology, Rigshospitalet, Copenhagen University Hospital. Blegdamsvej 9, 2100 Copenhagen, Denmark.

9The National Institute of Public Health, University of Southern Denmark. Øster Farimagsgade 5A, 1353 Copenhagen K, Denmark.

10Department of Cardiology, Copenhagen University Hospital Gentofte. Kildegårdvej 28, Post 635, 2900 Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen. Telegrafvej 5, 2750 Ballerup, Denmark.

 

Abstract

AIM:

It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC).

METHODS:

We included 1,316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0-5, 6-10, 11-15, 16-20, 21-25 and >25minutes of cardiopulmonary resuscitation (CPR) by emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes.

FINDINGS:

Median time from CPR initiation to ROSC was 12minutes (IQR: 7-18) while 20.4% achieved ROSC after >25minutes. Overall, 37.5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5minutes to 13.8% (19/138) for >25minutes. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12/55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals.

CONCLUSION:

Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile.

Copyright © 2016. Published by Elsevier Ireland Ltd.

PMID: 27224447 [PubMed - as supplied by publisher]