February 2013

Extending CPR Saves Lives, National Studies Find

Extending_CPR_Saves_Lives_National_Studies_Find

The Children’s Hospital of Philadelphia researchers contributed to two recent studies showing that extending cardiopulmonary resuscitation (CPR) longer than previously thought useful saves lives in both children and adults. The research teams analyzed the impact of duration of CPR in patients who suffered cardiac arrest while hospitalized.

“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 Children’s Hospital. Dr. Berg is also chair of the Scientific Advisory Board of the American Heart Association’s Get With Guidelines-Resuscitation program (GWTG-R), a national registry that tracks and analyzes the 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 of which was focused on children.

Dr. Berg was a co-author of the pediatric study, which was published recently in Circulation. After analyzing the hospital records of 3,419 children in the U.S. and Canada from 2000 through 2009, the investigators found that among children who suffered in-hospital cardiac arrest, more children than expected survived after prolonged CPR. Of those children who survived prolonged CPR — which is defined as lasting longer than 35 minutes — over 60 percent had good neurologic outcomes.

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

Another of the Circulation study’s co-authors, Vinay M. Nadkarni, M.D., a critical care and resuscitation science specialist at Children’s Hospital, 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 pediatric results parallel those found in the second GWTG-R investigation, which examined 64,000 adult patients with in-hospital cardiac arrests between 2000 and 2008. Dr. Berg also was also a co-author of that study, published in The Lancet in October 2012.

That study showed 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.

The American Heart Association and American Stroke Association named the Lancet study as the top finding of the year in heart disease and stroke research in its annual list of major advances. Going forward, CPR researchers will seek 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 Dr. Berg.

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