Resuscitation

Years ago, a local TV drama pictured a surgeon performing cardiopulmonary resuscitation on a patient who developed cardiac arrest in the middle of an operation. After eight hours of effort, the surgeon refused to let go. “She is already dead,” his colleagues tried to pull him away. “This is human life. We cannot give up,” he yelled back.

Of course, this does not happen in real life. Other than rare occasions such as hypothermia, prolonged resuscitation is futile and does not do the patient any good. However, how long a resuscitation attempt is too long?

In a recent paper, Zachary Goldberger and coworkers reported the findings from an American registry of 64339 patients with cardiac arrests at 435 hospitals [Lancet 2012;380:1473-81]. Overall, 15% of this cohort survived to discharge after successful resuscitation. The average duration of resuscitation was 12 minutes among patients with return of spontaneous circulation, compared to 20 minutes among non-survivors. When centers were classified according to the duration of resuscitation attempts among non-survivors, hospitals in the lowest quartile tried on average 16 minutes and hospitals in the highest quartile tried 25 minutes. The effort was translated into improved outcomes. Patients receiving resuscitation in hospitals in the highest quartile of attempt duration were 12% more likely to survive to discharge.

Thus, it is reassuring to learn that attempting more does help. This, however, still does not answer the original question – How long should we try then?