• Intern Emerg Med · Mar 2024

    Multicenter Study Observational Study

    Association between cardiopulmonary resuscitation duration and survival after out-of-hospital cardiac arrest according: a first nationwide study in France.

    • Deborah Jaeger, Martin Lafrance, Valentine Canon, Marinos Kosmopoulos, Christopher Gaisendrees, Guillaume Debaty, Demetri Yannopoulos, Hervé Hubert, Tahar Chouihed, and GR-RéAC.
    • Emergency Department, University Hospital of Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France. drdeborahjaeger@gmail.com.
    • Intern Emerg Med. 2024 Mar 1; 19 (2): 547556547-556.

    ObjectiveDetermining whether to pursue or terminate resuscitation efforts remains one of the biggest challenges of cardiopulmonary resuscitation (CPR). No ideal cut-off duration has been recommended and the association between CPR duration and survival is still unclear for out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the association between CPR duration and 30-day survival after OHCA with favorable neurological outcomes according to initial rhythm.MethodsThis was an observational, retrospective analysis of the French national multicentric registry on cardiac arrest, RéAC. The primary endpoint was neurologically intact 30-day survival according to initial rhythm.Results20,628 patients were included. For non-shockable rhythms, the dynamic probability of 30-day survival with a Cerebral Performance Category (CPC) of 1 or 2 was less than 1% after 25 min of CPR. CPR duration over 10 min was not associated with 30-day survival with CPC of 1 or 2 (adjusted OR: 1.67; CI 95% 0.95-2.94). For shockable rhythms, the dynamic probability of 30-day survival with a CPC score of 1 or 2, was less than 1% after 54 min of CPR. CPR duration of 21-25 min was still associated with 30-day survival and 30-day survival with a CPC of 1 or 2 (adjusted OR: 2.77; CI 95% 2.16-3.57 and adjusted OR: 1.82; CI 95% 1.06-3.13, respectively).ConclusionsSurvival decreased rapidly with increasing CPR duration, especially for non-shockable rhythms. Pursuing CPR after 25 min may be futile for patients presenting a non-shockable rhythm. On the other hand, shockable rhythms might benefit from prolonged CPR.© 2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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