What should be the appropriate duration of cardiopulmonary resuscitation

Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. Effectivity rate CPR oxygenates the body and brain, which favors making a later defibrillation advanced life support. On the other hand, delaying CPR often results in a poor outcome.

Lately, there has been much debate over the optimal amount of time to perform CPR and whether or not the longer duration of CPR can increase the survival rate of hospital cardiac. This is an important 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?

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 been shown to increase the victim’s chance of survival. It has also been demonstrated that out-of-hospital cardiac arrests occurring in public areas are more likely to be associated with initial ventricular fibrillation or pulseless ventricular tachycardia and have better survival rates.

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 for treatment of 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 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. For every minute without CPR, survival from witnessed ventricular fibrillation cardiac arrest decreases by 7–10%.

Overview In its full, standard form, CPR comprises 3 steps: chest compressions, airway, and breathing, to be performed in that order in accordance with American Heart Association guidelines. Some hospitals and emergency medical services systems employ devices to provide mechanical chest compressions, although such devices had not been shown to be more effective than high-quality manual compressions. There are several devices for improving CPR but, only defibrillators have been found better than standard CPR for an out-of-hospital cardiac.

Background out-of-hospital cardiopulmonary arrest is an important public health problem. The CPR duration required to achieve a return of spontaneous circulation 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 cardiopulmonary resuscitation and emergency cardiovascular care, untrained bystanders can perform COCPR in place of standard CPR or no CPR. However, an observational study involving more than 40,000 patients concluded that standard CPR was associated with increased survival and more favorable neurologic outcomes than COCPR was. 

According to 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 cardiopulmonary 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 hospital cardiac, 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 possibly 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 with the study period, additional research 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. 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 the survival rate.