Abstract 162: Calling the Code: Factors Influencing the Length of CPR
Background: Little is known about the determinants of the length of cardiopulmonary resuscitation (CPR) in hospitalized patients, and there are no current guidelines to assist health care providers in deciding when to terminate resuscitation.
Methods: A retrospective chart review was performed of 155 inpatient cardiac arrests occurring at an academic medical center. Unadjusted (t-test and chi square test) and adjusted (logistic regression) analyses were performed to determine the association between patient characteristics (age, race, gender, initial rhythm, and comorbidities) and hospital process factors (admitting service, day and time of cardiac arrest, and location of event) and CPR duration.
Results: The mean age of the sample was 62 ± 16 years, and 63% were male. The mean CPR duration was 17.8±15 minutes (range 2-77 minutes, median duration 13 minutes). The distribution was right skewed. The racial composition of the sample was as follows: 32% of individuals were black, 48% were white, and 20% were classified as other or unknown. CPR duration was inversely associated with ROSC compared with no-ROSC (63% vs. 37%; p<0.001) and survival to discharge compared with death (77% vs. 23%; p<0.001). Patients with longer CPR duration (>median) were younger than those with shorter CPR duration (< median, 60 vs. 65 years, p=0.05). Patients with chronic ventilator dependence were more likely to receive shorter CPR duration compared with patients without chronic ventilator dependence, (75% vs. 25%; p=0.008). There was a trend toward females undergoing shorter resuscitation when compared with males (62% vs. 38%; p=0.07). In multivariate analysis accounting for patient and hospital factors, the association between chronic ventilator dependence and CPR duration persisted (OR 0.22, 95% CI 0.066-0.75, p=0.02).
Conclusions: There is wide variability in the length of CPR, and CPR duration predicts both short and long-term outcomes. With the exception of chronic ventilator dependence, neither patient nor process factors are associated with CPR duration. In the absence of guidelines or prognostic tools to assist healthcare providers in determining when to terminate CPR, further research is needed to identify factors contributing to variability in CPR duration.
- © 2011 by American Heart Association, Inc.