Lately, there has been much debate over the optimal amount of time to perform Cardiopulmonary Resuscitation and whether or not the longer duration of CPR can increase the survival rate of hospital cardiac. Yet, this is an essential factor associated with the outcomes of an out-of-hospital cardiac. How long is CPR performed? How long should it be done? Does the amount of time CPR is performed have any bearing on achieving spontaneous circulation or survival rates?
Why is Time Critical with CPR?
Time is of the essence in Cardiopulmonary Resuscitation because for every minute that passes, the chances of surviving drop by 10%. After just four minutes, brain damage begins to occur. After ten minutes, it is unlikely they can be saved.
The most favorable neurological outcomes are achieved when CPR is performed immediately, and the CPR duration is 21-25 minutes. After that, the effectiveness of Cardiopulmonary Resuscitation may decline, and alternative methods such as ECPR should be considered.
According to the American Heart Association, Of the more than 300,000 cardiac arrests that occur annually in the United States, the success rate is typically lower than 10% for out-of-hospital cardiac and lower than 20% for in-hospital cardiac. Bystander CPR initiated within minutes of the onset of arrest has increased the victim’s chances of survival. It has also been demonstrated that out-of-hospital cardiac arrests in public areas are more likely to be associated with initial ventricular fibrillation or pulseless ventricular tachycardia and have better survival rates.
What should be the appropriate duration of CPR?
The duration of Resuscitation efforts was independently associated with the achievement of ROSC [odds ratio 1.18; 95% confidence interval (CI) 1.01–1.37, P = 0.04]. Emergency medical services professionals may give five cycles of CPR before attempting defibrillation to treat out‐of‐hospital cardiopulmonary arrest or pulseless ventricular tachycardia.
There are no clear-cut guidelines regarding how long CPR should be continued. The original thinking behind CPR suggested that prolonged CPR often resulted in permanent brain damage, and even if the cardiac arrest patient survived, they faced life-altering neurological issues.
On the contrary, a new study suggests that those who received continued CPR and achieved spontaneous circulation managed as well as those who were resuscitated quickly. The study suggests CPR can keep blood circulating for up to 30 minutes without brain damage. For every minute without CPR, survival from witnessed ventricular fibrillation cardiac arrest decreases by 7–10%.
What are the Steps of CPR?
Overview In its full, standard form, CPR comprises 3 steps to be performed in that order following American Heart Association guidelines:
- Chest compressions
Some hospitals and emergency medical services systems employ devices to provide mechanical chest compressions, although such devices are only as effective as high-quality manual compressions. In addition, there are several devices for improving CPR, but only defibrillators are better than standard CPR for an out-of-hospital cardiac.
Out of hospital Cardiac Arrest and CPR Duration Data
Out-of-hospital cardiac arrest is a significant public health problem. The CPR duration required to achieve a ROSC in >99% of out-of-hospital cardiac patients with a 1-month favorable neurological outcome was 45 min, considering both pre- and in-hospital settings. Based on the 2010 revisions of the American Heart Association Guidelines for CPR and emergency cardiovascular care, untrained bystanders can perform hands only CPR in place of standard CPR or no CPR.
A recent survey funded by the American Heart 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 out of hospital cardiopulmonary arrest. In addition, 15.4% of cases survived to discharge. The average duration of CPR during which patients survived was 12 minutes, and CPR was stopped after an average of 20 minutes for patients that expired. The mean duration varied by the hospital and was significantly different, ranging from 16 to 25 minutes.
According to the observational study results, data suggests that doctors may stop too soon and that prolonged CPR may prove beneficial. And it need not be significantly longer, suggesting that an additional 9 minutes of CPR could result in a 12% higher survival rate 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 crucial for medical professionals to take a fresh look at CPR guidelines considering the staggering number of hospital cardiac, between 1 and 5 out of every 100,000. In some cases, however, Nallamothu suggests that the additional period of time doing CPR may give doctors much-needed time to assess the situation and use other interventions. However, he cautions doctors from prolonging CPR when it is inappropriate for cardiac arrest patients, especially those terminally ill.
Additional research, observational studies, and clinical trials are 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.
If you are interested in learning basic life saving skills such as CPR, American Heart Association training centers and various training providers like USCPR online provides online training in CPR/AED, First Aid, and Basic Life Support. We strictly follow the American Heart Association guidelines for Emergency Cardiovascular Care in all of our training courses.