A patient undergoing cardiopulmonary resuscitation in a hospital setting, surrounded by a medical team, with dramatic tension in the air. Heart monitors and medical equipment show fluctuating vital signs as the doctors work intensively. The atmosphere is a mix of urgency and hope.
In a detailed examination of 348,996 adult patients, this study delves into the relationship between the duration of cardiopulmonary resuscitation (CPR) and patient outcomes after an in-hospital cardiac arrest. The results provide crucial insights that could guide clinical decision-making regarding the timing and duration of CPR efforts.
Lead author Dr. Masashi Okubo explained, “The probability of survival decreases with each passing minute of CPR, and at 39 minutes, it falls to less than 1%.” This finding emphasizes the importance of timely resuscitation efforts and may redefine CPR guidelines in hospital settings.
The team analyzed data from the Get With The Guidelines—Resuscitation (GWTG-R) registry, which collected cases from participating hospitals across the United States. The registry includes detailed information on adult patients who experienced cardiac arrest between 2000 and 2021, providing a robust data set for this analysis.
The Diminishing Returns of Prolonged CPR
Dr. Sho Komukai, a co-author, noted that the study’s findings reveal a sharp decline in favorable outcomes, such as survival to hospital discharge, as the duration of CPR increases. “At just seven minutes, 66.9% of patients achieved return of spontaneous circulation, but by 20 minutes, this rate dropped dramatically,” he said. “Knowing when to continue or stop CPR is crucial for better patient management.”
A Comprehensive Analysis Across Multiple Centers
This study is groundbreaking due to its large sample size and multicenter approach, analyzing data from various hospitals. “We aimed to quantify the time-dependent probabilities of survival and favorable outcomes, giving clinicians clear insights into the effects of prolonged CPR,” said Dr. Robert A. Berg. The authors emphasized that resuscitation teams must weigh the risks of extended CPR against the likelihood of meaningful recovery.
Implications for Clinical Practice
Dr. Clifton W. Callaway, another author, highlighted the real-world applications of these findings: “Our research provides valuable data that can help clinicians and families make more informed decisions during critical moments in cardiac arrest situations.” The study results may lead to updated CPR protocols and more personalized care for patients in cardiac distress.
Citation:
Okubo M, Komukai S, Andersen LW, Berg RA, Kurz MC, Morrison LJ, Callaway CW. Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study. BMJ. 2024;384. doi:10.1136/bmj-2023-076019.
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