Cardiac arrest survival improved by increased resuscitation time
Researchers: Extending resuscitation times by 10 to 15 minutes 'is a very small expense to be added, for potentially a large gain.'
Wed, Sep 05 2012 at 8:53 AM
Medical students in Germany practice the procedure for the resuscitation of a patient on a dummy. (Photo: Jan Woitas/ZUMA Press)
When a hospital patient's heart stops beating, exactly how long doctors should spend trying to revive him is not known. Now, a new study suggests that increasing resuscitation times may benefit patients.
In the study, patients whose hearts stopped were less likely to die if they were at a hospital that tended to spend a long time resuscitating patients, compared with a hospital that spent shorter times resuscitating patients.
In addition, longer resuscitation times did not appear to increase neurological problems among patients who survived.
While doctors should always use their best judgment in deciding whether to continue resuscitation attempts, the findings suggest increasing resuscitation times on a hospitalwide basis could improve patient survival, the researchers said.
Extending resuscitation times by 10 to 15 minutes "is a very small expense to be added, for potentially a large gain," said study researcher Dr. Zachary Goldberger, of the University of Washington School of Medicine in Seattle.
The researchers noted the study found only an association — not a direct cause-effect link — and was not designed to determine the optimal duration for resuscitation efforts.
Still, the findings suggest that setting a minimum time for resuscitation duration could improve patient outcomes, Goldberger said.
When a heart stops beating
Out of every 1,000 patients who stay in a hospital, between one and five experience cardiac arrest, a condition in which the heart stops beating. However, doctors have little evidence to guide them on how long they should spend trying to get a heart to beat again, and previous research has suggested that long-lasting resuscitation attempts are often futile, the researchers said.
In the new study, Goldberger and colleagues analyzed information from more than 64,000 patients, at 435 U.S. hospitals, who underwent resuscitation for a cardiac arrest between 2000 and 2008. The researchers determined how long each hospital typically spent trying to resuscitate by looking at the amount of time its staff spent resuscitating patients who did not survive. (Patients who survive often are revived after a short resuscitation time.)
About 48 percent of the patients in the study survived their cardiac arrest, but many died later during their hospital stay; only 15 percent of those in the study survived to be released from the hospital.
Patients at hospitals with the longest resuscitation times (typically 25 minutes) were 12 percent more likely to be revived and eventually discharged from hospital than those at hospitals with the shortest attempts (around 16 minutes), the researchers said.
The researchers were not able to take into account some factors — such as how well the chest compressions were done — and its possible longer resuscitation times were simply a marker of better care in general, the researchers said.
Each case is different
It's very difficult to make broad recommendations on how long resuscitation should continue because each case is different, said Dr. Roger White, an anesthesiologist at Mayo Clinic specializing in resuscitation care, who was not involved in the study. Doctors need to quickly decide whether a patient stands a good chance of being revived, based on such factors as the number of health conditions they have, White said.
Long resuscitation attempts can be justified, White said, especially if doctors have objective measurements to guide them on how well the resuscitation is going. Such measurements include changes in heart rhythm, and the amount of blood that reaches vital organs, White said.
The new study will be published on Sept. 5 in the journal the Lancet.
Pass it on: For those who have a cardiac arrest in the hospital, increasing resuscitation times may improve patients' survival.
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