Abstract 94: Are Longer Resuscitation Efforts Associated with Improved Survival During In-Hospital Arrest? An Analysis from the GWTG--Resuscitation
Background How long resuscitation attempts should continue prior to the termination of efforts is unknown for in-hospital cardiac arrests. We hypothesized that resuscitation duration in non-survivors varies across hospitals and that patients at hospitals with longer attempts have improved survival.
Methods We identified 70,156 patients with in-hospital cardiac arrests between 2000 and 2009 at 440 hospitals within a large national registry. We stratified hospitals into quartiles of equal size based on their median duration of resuscitation attempts prior to the termination of efforts in patients who did not achieve return of spontaneous circulation (ROSC). Through hierarchical modeling, we then assessed whether patients at hospitals with longer median resuscitation durations among their non-survivors had higher risk-adjusted survival.
Results The overall proportion of patients achieving ROSC was 48.5%. Among non-survivors, the median resuscitation duration was 20 minutes, with efforts terminated within 10 minutes in 15.5% and within 30 minutes in 76.3%. Compared with patients at hospitals in the quartile with the shortest resuscitation duration among their non-survivors, patients at hospitals with longer resuscitation durations had an increasing likelihood of achieving ROSC (p<0.001 for trend, Table). These findings were driven largely by a higher likelihood of achieving ROSC at later points during the cardiac arrest for patients at hospitals with longer resuscitation durations, and were most pronounced for cardiac arrests due to pulseless electrical activity and asystole. Rates of survival to discharge showed a similar pattern of results.
Conclusions Duration of resuscitation attempts varies substantially across hospitals during in-hospital cardiac arrest. Patients at hospitals with longer resuscitation durations have a higher likelihood of ROSC and survival to discharge.
- © 2011 by American Heart Association, Inc.