There has been much debate lately over the optimal amount of time to perform Cardiopulmonary Resuscitation (CPR) and whether or not the longer duration of CPR can increase survival rates. How long is CPR performed? How long should it be done and does the amount of time CPR is performed have any bearing on achieving spontaneous circulation or survival rates?
There are no clear-cut guidelines regarding how long CPR should be continued. The original thinking behind performing CPR suggested that prolonged CPR often resulted in permanent brain damage and, even if patients survived, they faced life-altering neurological issues as a result. On the contrary, a new study suggests that those who receive continued CPR and achieve spontaneous circulation managed as well as those who were resuscitated quickly. As a matter of fact, the study suggests CPR can keep blood circulating for up to 30 minutes without brain damage.
According to a recent survey funded by the American Hospital Association, the Robert Wood Johnson Foundation and the National Institutes of Health and published in The Lancet considered 64,339 cases of CPR at 435 U.S. hospitals between the years 2000-2008 and found that 48.5% of patients attained “spontaneous circulation” following cardiac arrest. 15.4% of cases survived to discharge. The average duration of CPR during which patients survived was 12 minutes, and for patients that expired, CPR was stopped after an average of 20 minutes. The mean duration varied by the hospital and was significantly different, ranging from 16 to 25 minutes.
According to the results of the study, data suggests that doctors may be stopping too soon and that prolonged CPR may actually prove to be beneficial. And it need not be significantly longer, suggesting that an additional 9 minutes of CPR could result in a 12% higher rate of survival without negatively affecting neurological functioning.
The lead author, cardiologist Dr. Brahmajee Nallamothu, is hoping the results of this study will lead to new discussions regarding optimal CPR duration. It is important for medical professionals to take a fresh look at CPR guidelines considering a staggering number of hospitalized patients suffer cardiac arrest, between 1 and 5 out of every 100,000. In some cases, however, Nallamothu suggests that the additional time doing CPR may give doctors much needed time to assess the situation and possible use other interventions, however, he cautions doctors from prolonging CPR when it is not appropriate for patients, especially those who are terminally ill.
This was one of the first studies of its kind, and additional research is still needed to determine the optimal duration of CPR. However, this data gives medical professionals an excellent opportunity to assess where their hospitals lie on the length spectrum. Nallamothu strongly suggests that hospitals whose CPR times put them on the low end may wish to reassess their guidelines and consider prolonging CPR to increase survival rates.