Longer CPR improves survival in both chidren and adults

"These findings about the duration of CPR are game-changing, and we hope these results will rapidly affect hospital practice," said Robert A. Berg, M.D., chief of Critical Care Medicine at The Children's Hospital of Philadelphia. Berg is the chair of the Scientific Advisory Board of the American Heart Association's Get With Guidelines-Resuscitation program (GWTG-R). That quality improvement program is the only national registry that tracks and analyzes 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 January 2013, the other in adults, published in October 2012.

Berg was a co-author of the pediatric study, appearing online January 21 in Circulation, which analyzed hospital records of 3,419 children in the U.S. and Canada from 2000 through 2009. This study, whose first author was Renee I. Matos, M.D., M.P.H., a mentored young investigator, 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 percent had good neurologic outcomes.

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

In addition to Berg, two other co-authors are critical care and resuscitation science specialists at The Children's Hospital of Philadelphia: Vinay M. Nadkarni, M.D., and Peter A. Meaney, M.D., M.P.H.

Nadkarni noted that illness categories affected outcomes, with children hospitalized for cardiac surgery having better survival and neurological outcomes than children in all other patient groups.

The overall pediatric 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 Oct. 27, and led by Brahmajee K. Nallamothu, M.P.H., M.D., of the University of Michigan. Patients at hospitals in the top quartile of median CPR duration (25 minutes), had a 12 percent 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.