In-hospital cardiac arrest: shorter CPR can mean better survival

  • Rohlin O & al.
  • Resuscitation
  • 20 Aug 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • During in-hospital cardiac arrest (IHCA) with return of spontaneous circulation (ROSC), briefer CPR is associated with better survival.
  • However, CPR duration is not a reliable marker of futility in such resuscitations.

Why this matters

  • Some 200,000 IHCA resuscitations occur annually in the United States.
  • Optimum duration of resuscitation attempt is unknown.
  • How duration of resuscitation relates to mortality has been unclear.

Key results 

  • 30-day survival was 471 (56%).
  • Among 768 (91%) of 840 immediate survivors, median CPR duration was 5 minutes (interquartile range, 2-12 minutes). 
  • Factors associated with survival: 
    • Arrest in cath lab, regardless of duration;
    • Witnessed arrests in Q1, Q2;
    • Shockable rhythm, regardless of duration.
  • Survival vs Q1 (aOR):
    • Q2: 0.69 (95% CI, 0.37-1.29);
    • Q3: 0.35 (0.19-0.65);
    • Q4: 0.10 (0.05-0.20).  
  • 90%, 95%, and 99% of survivors underwent CPR for ≤15, 20, and 60 minutes, respectively.
  • In Q4, 30% survived to ≥30 days.

Study design

  • Hospital-based retrospective cohort study of 840 consecutive adults experiencing IHCA with ROSC during 10-year period at Sweden's Karolinska University Hospital.
  • Researchers stratified survivors by quartile according to CPR duration:
    • Q1:
    • Q2: 3-5 minutes;
    • Q3: 6-12 minutes;
    • Q4: ≥13 minutes.
  • Outcome was 30-day survival.
  • Funding: Karolinska Institutet.

Limitations

  • Potential residual confounding from post-ROSC treatments.

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