Longer CPR improves survival in both children and adults

237

Experts from The Children’s Hospital of Philadelphia were among the leaders of two large national studies showing that extending CPR longer than previously thought useful saves lives in both children and adults. The research teams analysed impact of duration of cardiopulmonary resuscitation in patients who suffered cardiac arrest while hospitalised.

“These findings about the duration of CPR are game-changing, and we hope these results will rapidly affect hospital practice,” said Robert A Berg, chief of Critical Care Medicine at The Children’s Hospital of Philadelphia, USA. Berg is the chair of the Scientific Advisory Board of the American Heart Association’s Get With Guidelines-Resuscitation programme (GWTG-R). That quality improvement programme is the only national registry that tracks and analyses resuscitation of patients after in-hospital cardiac arrests.

The investigators reported data from the GWTG-Resuscitation registry of CPR outcomes in thousands of North American hospital patients in two landmark studies—one in children, published on 21 January 2013, the other in adults, published in October 2012.


Berg was a co-author of the paediatric study, in Circulation, which analysed hospital records of 3,419 children in the USA and Canada from 2000 through 2009. This study, whose first author was Renee I Matos, found that among children who suffered in-hospital cardiac arrest, more children than expected survived after prolonged CPR—defined as CPR lasting longer than 35 minutes. Of those children who survived prolonged CPR, over 60% had good neurologic outcomes.


The conventional thinking has been that CPR is futile after 20 minutes, but Berg said these results challenge that assumption.


The overall paediatric results paralleled those found in the adult study of 64,000 patients with in-hospital cardiac arrests between 2000 and 2008. Berg also was a co-author of that GWTG-R study, published in The Lancet on 27 October, and led by Brahmajee K Nallamothu, University of Michigan. Patients at hospitals in the top quartile of median CPR duration (25 minutes), had a 12% higher chance of surviving cardiac arrest, compared to patients at hospitals in the bottom quartile of median CPR duration (16 minutes). Survivors of prolonged CPR had similar neurological outcomes to those who survived after shorter CPR efforts.


The American Heart Association and American Stroke Association designated the adult study as the top finding of the year in heart disease and stroke research in its annual list of major advances. Next steps for CPR researchers are to identify important risk and predictive factors that determine which patients may benefit most from prolonged CPR, and when CPR efforts have become futile. “Taken together, the adult and pediatric results present a clear and hopeful message: persisting longer with CPR can offer better results than previously believed possible,” concluded Berg.