PHOENIX, ARIZ.—Despite an American Heart Association recommendation that cardiopulmonary resuscitation stop if patients do not respond within 30 minutes, a review of one emergency department's experience found the average effort lasted significantly longer.
Mean total resuscitation time was 66 minutes when cardiopulmonary resuscitation (CPR) began before the patient arrived at the hospital, and 36 minutes if CPR was started in the emergency department, emergency physicians Lara Wagner, M.D., and Jared Strote, M.D., reported at a meeting sponsored by the Society of Critical Care Medicine.
The duration of CPR was also significantly longer in medical cases than in trauma cases, a difference that was statistically significant. A chart review of failed attempts showed average times of 73 minutes and 51 minutes, respectively. The average for all attempts was 55 minutes.
“It appears a lot was due to the clock being restarted when paramedics arrived at the emergency department,” said Dr. Strote of the University of Washington Medical Center in Seattle. One possibility, he suggested, was that “the doctors were not taking into account all the resuscitation that was happening in the field.”
Another explanation could be that the paramedics or the emergency physicians thought they saw a response in the patients who arrived by ambulance, said Dr. Wagner, a resident at the university. “At any point during resuscitation efforts, did they … regain a rhythm and start again?” she asked.
The study reviewed charts of 126 patients who died after resuscitation attempts from September 2001 to August 2003. These included 76 trauma cases and 50 medical arrests. In 83 cases, CPR was started before the patients arrived in the emergency department; the other 43 patients went into arrest in the ED. Thirteen patients had “Do not resuscitate” orders.
Analysis by age, gender, and race did not turn up significant differences, the authors reported. They speculated that the longer time spent in medical cases “may be due in part to longer medical arrest field resuscitation time versus a 'scoop and run' trauma arrest strategy.”
The phenomenon needs to be addressed, according to Dr. Strote, because longer-than-appropriate resuscitation times can be harmful. “It's hurting other patients in terms of resources that are being used,” he said. “And after 30 minutes, [the resuscitated patients'] chance of reasonable recovery is near zero, but there does remain a chance they will recover with brain damage or significant organ damage.”
The ongoing study has been expanded to review more patients and more years, Dr. Wagner added. “We're looking to see what is going on in the 30 minutes or so before they arrive at the ED,” she said.