Longer Resuscitation After Cardiac Arrest May Be Warranted, Study Suggests
TUESDAY Sept. 4, 2012 -- Longer resuscitation efforts improve the chances of survival in patients who suffer cardiac arrest in a hospital, new research contends.
The finding, published Sept. 4 in The Lancet, may be controversial, since it challenges the common belief that it's futile to extend resuscitation in patients who do not respond immediately, the study authors said.
However, study lead author Zachary Goldberger of the University of Washington said the new findings "suggest that prolonging resuscitation efforts by 10 or 15 minutes might improve outcomes."
Speaking in a Lancet news release, he added that extending resuscitation would not use up much more medical resources and have only "modest" effects on the patient's neurological health, should he or she survive.
In the study, Goldberger's team analyzed data from more than 64,000 patients at 435 U.S. hospitals who underwent resuscitation after suffering a cardiac arrest between 2000 and 2008. There was wide variation in the average duration of resuscitation attempts at the hospitals.
However, patients at hospitals where resuscitation efforts lasted the longest were more likely to be successfully revived (restoration of heart beat for at least 20 minutes) and to survive to be discharged from the hospital than patients at hospitals where resuscitation attempts were shortest.
The percentage of patients who survived to hospital discharge and had little or no brain damage was similar regardless of the length of resuscitation, the study found.
The researchers said their findings can't be used to define the ideal duration for resuscitation attempts, but do suggest that establishing minimum lengths of time for resuscitation may help improve outcomes in patients who suffer cardiac arrest in a hospital.
Currently, survival for these patients is low. Between one and five of every 1,000 hospitalized patients in developed countries suffer a cardiac arrest, and fewer than 20 percent of those patients survive to be discharged, according to journal background information.
Two specialists were cautious about the findings.
"It is difficult to draw definitive conclusions from this study," said Dr. Kenneth Ong, acting chair of the department of medicine and cardiology at The Brooklyn Hospital Center, in New York City.
"There are many variables that affect a person's survival after cardiac arrest," he said. "As the authors correctly point out, few guidelines exist to assist the resuscitation team, including the duration of the attempt. It is possible that those who survive and undergo the longest resuscitative efforts may have clinical features pointing toward success compared with those who may be judged medically futile by the caretakers and thus have a shorter period of resuscitation."
Another expert said the finding may not apply to most cardiac arrest patients.
"From clinical experience, overall survival after in-hospital cardiac arrest is quite poor when there is no clear reversible cause for the arrest," noted Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital, in New York City. "However, when there is a potentially reversible cause for the arrest, successful resuscitation efforts may potentially improve. This suggests that in these limited clinical situations, there may be a window of opportunity to improve care by increasing duration of resuscitation time prior to termination of efforts."
Glatter added, however, that the study "did not demonstrate that longer resuscitation efforts resulted in a higher percentage of patients who were neurologically intact upon discharge." He believes that there is no specific, ideal duration for resuscitation and decisions must be made on a case-by-case basis.
Also, Glatter noted, "this study was purely observational, and therefore cannot directly demonstrate a causal relationship between length of resuscitation and improvements in survival."
The U.S. National Heart, Lung, and Blood Institute has more about treatment of cardiac arrest.
Posted: September 2012
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