More children than expected survive cardiac arrests in hospital following prolonged resuscitation, new research in America shows.
The study should help to dispel common perceptions that CPR is futile beyond 20 minutes, said lead investigator Dr Renee Matos from the University of Pittsburgh School of Medicine in Pennsylvania.
The study closely follows another that showed these children are more and more likely to live, with survival rates almost tripling over the past decade.
The latest survey reported, however, that children with certain illnesses seem to respond better to prolonged CPR than others. They found that surgical, cardiac patients had the best outcomes and severely injured patients had the worst. “But rapid, high-quality CPR is important”, said Dr Matos.
While the new findings have implications for children’s hospital care, they do not provide a simple solution for when to discontinue CPR, he said. Further studies are needed to determine whether prolonged resuscitative efforts are warranted in particular groups of patients.
The researchers looked at the outcomes of 3419 children at 328 US and Canada hospitals who suffered a cardiac arrest in hospital between January 2000 and December 2009.
They looked at survival after CPR of one to 15 minutes, 16 to 35 minutes, and more than 35 minutes.
Survival was 42 per cent for CPR of one to 15 minutes and 12 per cent for more than 35 minutes, although the latter figure was as high as 16.2 per cent in certain patient groups. Researchers said the study suggested that some children who would presumably have died without CPR survived without brain damage even after prolonged resuscitation.
The earlier study, which showed the trebling of survival rates in children who have a cardiac arrest in hospital, mirrored recent findings for adults, said Dr Saket Girotra from the University of Iowa Hospitals and Clinics, Iowa City in a report published in the online Circulation: Cardiovascular Quality and Outcomes last month.
He said: "We found a significant improvement in survival in children since 2000. The magnitude of improvement was pretty dramatic, from 14.3 per cent in 2000 to 43.4 per cent in 2009," said Dr Girotra. He added: "This improvement was not accompanied by any worsening in rates of neurological impairment in these children."
Dr Girotra and his colleagues looked at 1031 children under the age of 18 from 12 hospitals in the national Get With the Guidelines—Resuscitation registry. Improvements occurred in all age categories — newborns, toddlers and older children—and the overall improvement in survival was largely due to an improvement in the initial resuscitation effort, Dr Girotra said.
"It's hard to tease out what are some of the specific initiatives that would have led to the improvement in survival," Dr Girotra said. "I can speculate that it has to do with better, earlier recognition of patients who are at risk of or having a cardiac arrest; quicker response times; focus on improvement and quality of chest compressions and CPR efforts; and better care of these patients once they have been resuscitated."
However, he stressed that these data do not allow determination of which of these specific factors or combination of factors are responsible for the improvements observed. "Future studies will have to look into this," he said.
No related pages or links.