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Written by Joshua Belfer
In a cohort of 1,007 children, longer CPR duration after a cardiac arrest lowered the chances of positive neurologic outcomes, with the likelihood of moderate disability or better dropping below 1% after 64 minutes of CPR.
The 64-minute tipping point
In pediatrics, determining when to terminate a resuscitation is an incredibly difficult decision. Multiple studies have shown that a longer prehospital CPR duration is associated with worse neurologic outcomes. This retrospective cohort study assessed the relationship between prehospital and in-hospital CPR durations and neurological outcomes in pediatric out-of-hospital cardiac arrests using data from the Japanese Association for Acute Medicine-OHCA Registry. Among 1,007 cases, only 5% achieved moderate disability or better outcomes. Neurological prognosis declined sharply with prolonged CPR, with less than 1% of patients exhibiting 1-month moderate disability or better neurological outcomes when CPR duration was more than 64 minutes. One limitation of the study is that CPR duration could not be analyzed as a continuous variable, making it unclear if the likelihood of good neurologic outcome decreased every minute.
How will this change my practice?
This study highlights the critical importance of timing in pediatric CPR and provides additional evidence for decision-making during resuscitation. While terminating a resuscitation is an extremely difficult decision that takes into account more than strictly the medical factors, the evidence will help guide my approach to prolonged resuscitation. These results can help better communicate prognosis to families and determine when to transition from aggressive interventions to compassionate care. The findings reinforce the need for efficient prehospital and in-hospital workflows, emphasizing the importance of optimizing systems that minimize delays and focusing on interventions that enhance survival with good neurological outcomes.
Source
Duration of prehospital and in-hospital cardiopulmonary resuscitation and neurological outcome in paediatric out-of-hospital cardiac arrest. Emerg Med J. 2024 Nov 21;41(12):742-748. doi: 10.1136/emermed-2023-213730. PMID: 39406464
