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Many hospitalised children who require prolonged CPR survive

Many hospitalised children can survive cardiac arrest after prolonged cardiopulmonary resuscitation (CPR), according to new research published in Circulation.1

Researchers analysed records of 3,419 children at 328 USA and Canadian hospitals participating in the American Heart Association’s Get With The Guidelines® resuscitation programme from January 2000–December 2009. The programme is aimed at improving care and saving lives by tracking and analysing resuscitation of in-hospital cardiac arrests.

The study showed that nearly 28% of resuscitated patients survived to hospital discharge. About 17% of these patients underwent CPR for more than 35 minutes. Of those who survived, 60% had good neurologic outcomes.

“This study dispels common misperceptions that CPR is futile beyond 20 minutes,” said lead author Dr Renée I Matos, (Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center). “We believe that healthcare providers now will consider longer-duration CPR for some patients, and that a thoughtful approach to providing longer durations of CPR to some children will save more lives”.

Although many patients survived after prolonged CPR, shorter durations were associated with better survival rates overall. Main findings included that:

  • On average, resuscitation time among surviving patients was 10 minutes, compared to 25 minutes among those who died
  • The adjusted probability of survival was 41% for CPR duration of 1–15 minutes and 12% for more than 35 minutes
  • Compared to general medical patients, cardiac surgery patients had more than twice the odds for survival and favorable neurologic outcomes across all durations of CPR
  • Overall, almost one-fifth (19%) of surviving patients who required CPR during their hospitalisation had favorable outcomes.

“The probability of survival and favorable neurologic outcome decrease with each passing minute,” Dr Matos said. “So while these results are supportive of doing CPR longer, it’s still critical that high-quality life support be started immediately”.

In many cases, cardiac arrest in hospitalised children may be due to a pre-existing lung or heart condition or other factors, the authors said. Survival depends on immediate CPR to restore normal heart rhythm and blood circulation, they added.

References

1. Matos RI, Watson RS, Nadkarni VM, et al. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation 2013. http://dx.doi.org/10.1161/​CIRCULATIONAHA.112.125625/

Published on: January 25, 2013

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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