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Can Prolonged CPR Save More Cardiac Arrest Patients? CPR (Cardiopulmonary resuscitation) is an emergency procedure performed on a person whose heart has stopped or who is no longer breathing. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart hoping to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. In hospitals, statistics showed that for every 1000 patients, between 1 and 5 might suffer a cardiac arrest. These patients are usually older and sicker than non-hospitalized patients who suffer cardiac arrest and their outcomes are generally poor. When a patient at a hospital goes into cardiac arrest, for instance, how long should the medical team persists with CPR to save this person’s life? This is often a very difficult-to-answer question facing many medical professionals. Thus far, there have not been any firm guidelines on how long to keep trying to revive someone whose heart has stopped. A general belief is that prolonged resuscitation for hospitalized patients is usually useless since even if patients do survive, they often suffer permanent neurological damage. But in a paper published on September 5, 2012 in medical journal ‘Lancet’, researchers from University of Michigan argued that prolonging resuscitation efforts by 9 minutes, on average, might help patients have better chance of survival. Moreover, they were also not more likely to be disabled or brain-damaged than those who revived more quickly.
The study, which was funded by the American Hospital Association, the Robert Wood Johnson Foundation and the National Institutes of Health, investigated whether duration of CPR attempts varies among hospitals and whether patients at hospital that attempt CPR for longer have higher survival rates than those at hospitals with shorter durations of CPR effort. Researchers looked at records of 64,339 patients from 435 hospitals in the United States that suffered cardiac arrest in hospitals between 2000 and 2008. They divided the hospitals into 4 groups according to average duration to revive patients: 25, 22, 19 and 16 minutes. The difference between the longest and the shortest is more than 50 percent. Only 15.4 percent (9912 out of 64339) of all the patients survived to discharge. Patients in hospitals with the longest CPR efforts were 12 percent more likely to survive and be discharged from hospital than those with the shortest durations. And yet the neurological function was similar, regardless of the CPR duration. Patients who were most beneficial from prolonged CPR were those whose conditions do not respond to defibrillation or being shocked, according to researchers. The extra time spent on prolonged CPR might furnish doctors time to analyze the situation and try different interventions. There were other factors that could affect the survival rates. The patients could be sicker at some hospitals than others, and some hospitals could have patients who are older and less likely to survive, and yet some hospitals might have staffs that are more skilled at reviving patients. While the findings neither indicated longer CPR is better for every patient nor identified an optimal duration for all patients at the hospital, they did suggest that efforts to increase the duration of resuscitation could improve survival rate in the high-risk population. But the findings only apply to hospital resuscitation, and not CPR or other rescue attempts outside a hospital. Some doctors felt that trying for longer does not necessarily hurt if the cause of cardiac arrest is potentially reversible. There are, however, concerns among others that the new findings could lead to protracted efforts to revive some patients who are inappropriate because they are at the end of their lives or for other reasons. Generally, the new findings should prompt hospitals to review what they are doing and consider changing their practices if their resuscitation efforts fall short. They definitely do not want to be on the low end of the curve.
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