How long should CPR be given to cardiac arrest patients in hospital?

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Cardiac arrest is a life-threatening condition that occurs when the heart stops beating and blood stops flowing to vital organs. It is different from a heart attack, which is caused by a blockage in a blood vessel that supplies the heart.

CPR duration and survival outcomes

Cardiopulmonary resuscitation (CPR) is a procedure that involves chest compressions and artificial breathing to restore blood circulation and oxygen delivery to the body. CPR can be performed by anyone who is trained and willing to help, but it is most effective when done by medical professionals in a hospital setting.

However, CPR is not always successful, and the longer it is performed, the lower the chances of survival and recovery for the patient. A new US study published by The BMJ today reveals that the probability of a patient living and leaving the hospital with good or moderate brain function drops from 22% and 15%, respectively, after one minute of receiving CPR to less than 1% for both outcomes after 39 minutes and 32 minutes of no heartbeat.

CPR duration and survival outcomes

The study analyzed data from 348,996 US adults (average age 67 years) who had a cardiac arrest in a hospital between 2000 and 2021. They defined CPR as the time between the start of chest compressions and the first return of spontaneous circulation (ROSC) or the end of resuscitation efforts. They also adjusted for factors that could affect the results, such as age, sex, race, and underlying health conditions.

Implications for decision making

The researchers say that these findings can help hospital staff, patients, and their relatives make informed decisions about when to stop or continue CPR. They acknowledge that there is no clear guidance on how long CPR should be given before it is considered futile, and that each case should be evaluated individually based on the patient’s preferences and prognosis.

However, they suggest that after 20 minutes of CPR without ROSC, the likelihood of survival and favorable functional outcome is very low, and further resuscitation may not be beneficial. They also recommend that hospitals monitor and report their CPR duration and outcomes to improve their resuscitation performance and quality of care.

Limitations and future research

The study has some limitations, such as relying on the assumption that any termination of resuscitation was appropriate, and not accounting for the severity of underlying conditions and the quality of CPR or post-resuscitation care at each hospital. The researchers also note that collecting time variables during CPR is difficult and prone to errors.

They call for more research to validate their findings and to explore the factors that influence CPR duration and outcomes, such as the cause of cardiac arrest, the initial heart rhythm, the use of advanced life support interventions, and the availability of extracorporeal membrane oxygenation (ECMO), a machine that can take over the function of the heart and lungs.

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