How long is long enough for hospital resuscitation?

It was a pleasant surprise last week to hear Jerry Nolan being interviewed on the Today programme on BBC Radio 4, regarding a new study just published online in The Lancet entitled – ‘Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study’.

It is currently unknown how long resuscitation should be continued for in-hospital cardiac arrests, whether the length of resuscitation attempts varies between hospitals, and whether patients at hospitals who attempt resuscitation for longer periods of time have higher survival rates.

This observational study, using the largest known database of in-hospital cardiac arrests, the AHA ‘Get with the Guidelines – Resuscitation Registry (formerly known as the National Registry of Cardiopulmonary Resuscitation – NRCPR), identified over 64,000 patients between 2000 and 2008 from 435 USA hospitals who had a cardiac arrest. The length of time resuscitation was attempted in patients who did not survive was used as a measure of the hospital’s overall tendancy for continuing CPR for longer time periods. The primary endpoints were immediate survival with ROSC and survivial to hospital discharge.

The results showed a variation between hospitals for the duration of resuscitation attempts. They also found that patients at hospitals who attempted resuscitation for longer time periods were more likely to survive to hospital discharge. Multilevel regression models were used to assess the relationship between the length of resuscitation efforts and risk-adjusted survival. The authors concluded that their findings suggested ‘efforts to systematically increase the duration of resuscitation could improve survival in this high risk population’.

Jerry Nolan and Jasmeet Soar provide further background and context to this study in the article ‘Duration of in-hospital resuscitation: when to call time?’, also published in The Lancet.