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Many hospitalized children who require prolonged CPR survive

American Heart Association 
News Release (AHA)

January 22, 2013

Study Highlights:

  • Many hospitalized children survive after prolonged resuscitation (more than 35 minutes) for cardiac arrest.
  • Over half of survivors of prolonged resuscitation had good neurologic outcomes.
  • Longer duration of CPR, previously associated with helpless outcomes, may save the lives of children who otherwise would have died.

Many hospitalized children can survive cardiac arrest after prolonged CPR, according to new research in Circulation, an American Heart Association journal.

In the largest study conducted of in-hospital cardiac arrest among children, researchers analyzed records of 3,419 children at 328 U.S. and Canadian hospitals participating in the American Heart Association’s Get With The Guidelines®-Resuscitation program from January 2000 -December 2009. The program is the only registry of its kind in the United States and is aimed at improving care and saving lives by tracking and analyzing resuscitation of in-hospital cardiac arrests.

Nationally, 0.7 percent to 3 percent of hospitalized children suffer cardiac arrest. Experts have previously considered duration of CPR longer than 20 minutes to be futile.

In this study, researchers found that nearly 28 percent of resuscitated patients survived to hospital discharge. About 17 percent of these patients underwent CPR for more than 35 minutes. Of those who survived, 60 percent had good neurologic outcomes.

“This study dispels common misperceptions that CPR is futile beyond 20 minutes,” said Renée I. Matos, M.D., M.P.H., the study’s lead author and a recent fellowship graduate in pediatric critical care at Children’s Hospital of Pittsburgh of the 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.

  • 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 percent for CPR duration of 1-15 minutes and 12 percent 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 percent) of surviving patients who required CPR during their hospitalization had favorable outcomes.

“The probability of survival and favorable neurologic outcome decrease with each passing minute,” 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 hospitalized children may be due to a preexisting lung or heart condition or other factors. Survival depends on immediate CPR to restore normal heart rhythm and blood circulation.

The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care acknowledge that there is not yet enough scientific evidence to guide the ability to tell when further efforts would be futile for an individual patient and do not currently recommend a specific duration for resuscitation attempts.

 Information gathered in the association’s quality improvement programs like Get With The Guidelines-Resuscitation helps generate critical questions and provide answers that can improve care for patients everywhere.

Co-authors are R. Scott Watson, M.D., M.P.H.; Vinay M. Nadkarni, M.D.; Hsin-Hui Huang, M.D., M.P.H.; Robert A. Berg, M.D.; Peter A. Meaney, M.D., M.P.H.; Christopher L. Carroll, M.D.; Richard J. Berens, M.D.; Amy Praestgaard, M.S.; Lisa Weissfeld, Ph.D.; and Philip C. Spinella, M.D. Author disclosures are on the manuscript.

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