Duration of resuscitation eff orts and survival after in-hospital cardiac arrest: an observational study

Summary Background During in-hospital cardiac arrests, how long resuscitation attempts should be continued before termination of eff orts is unknown. We investigated whether duration of resuscitation attempts varies between hospitals and whether patients at hospitals that attempt resuscitation for longer have higher survival rates than do those at hospitals with shorter durations of resuscitation eff orts. Methods Between 2000 and 2008, we identifi ed 64 339 patients with cardiac arrests at 435 US hospitals within the G et With The Guidelines—Resuscitation registry. For each hospital, we calculated the median duration of resuscitation before termination of eff orts in non-survivors as a measure of the hospital’s overall tendency for longer attempts. We used multilevel regression models to assess the association between the length of resuscitation attempts and riskadjusted survival. Our primary endpoints were immediate survival with return of spontaneous circulation during cardiac arrest and survival to hospital discharge. Findings 31 198 of 64 339 (48·5%) patients achieved return of spontaneous circulation and 9912 (15·4%) survived to discharge. For patients achieving return of spontaneous circulation, the median duration of resuscitation was 12 min (IQR 6–21) compared with 20 min (14–30) for non-survivors. Compared with patients at hospitals in the quartile with the shortest median resuscitation attempts in non-survivors (16 min [IQR 15–17]), those at hospitals in the quartile with the longest attempts (25 min [25–28]) had a higher likelihood of return of spontaneous circulation (adjusted risk ratio 1·12, 95% CI 1·06–1·18; p<0·0001) and survival to discharge (1·12, 1·02–1·23; 0·021).