Age, Sex, and Hospital Factors Are Associated With the Duration of Cardiopulmonary Resuscitation in Hospitalized Patients Who Do Not Experience Sustained Return of Spontaneous Circulation

• Published in: Journal of the American Heart Association Vol. 3; no. 6; pp. e001044 - n/a
• Main Authors: Khan, Abigail M., Kirkpatrick, James N., Yang, Lin, Groeneveld, Peter W., Nadkarni, Vinay M., Merchant, Raina M.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-12-2014
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Blood Circulation; cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Female; heart arrest; Heart Arrest - diagnosis; Heart Arrest - etiology; Heart Arrest - mortality; Heart Arrest - physiopathology; Heart Arrest - therapy; Hospital Mortality; Humans; Inpatients; Logistic Models; Male; Middle Aged; Odds Ratio; Original Research; Recovery of Function; Registries; resuscitation; Resuscitation Orders; Retrospective Studies; Risk Factors; Sex Factors; survival; Tachycardia, Ventricular - complications; Time Factors; Treatment Outcome; United States; Ventricular Fibrillation - complications; Young Adult; United States
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.114.001044

Background
Variability in the duration of attempted in‐hospital cardiopulmonary resuscitation (CPR) is high, but the factors influencing termination of CPR efforts are unknown.
Methods and Results
We examined the association between patient and hospital characteristics and CPR duration in 45 500 victims of in‐hospital cardiac arrest who did not experience return of spontaneous circulation (ROSC) and who were enrolled in the Get With the Guidelines registry between 2001 and 2010. In a secondary analysis, we performed analyses in 46 168 victims of in‐hospital cardiac arrest who experienced ROSC. We used ordered logistic regression to identify factors associated with CPR duration. Analyses were conducted by tertile of CPR duration (tertiles: ROSC group: 2 to 7, 8 to 17, and 18 to 120 minutes; no‐ROSC group: 2 to 16, 17 to 26, 27 to 120 minutes). In those without ROSC, younger age (aged 18 to 40 versus >65 years; odds ratio [OR] 1.81; 95% CI 1.69 to 1.95; P<0.001), female sex (OR 1.05; 95% CI 1.02 to 1.09; P=0.005), ventricular tachycardia or fibrillation (OR 1.50; 95% CI 1.42 to 1.58; P<0.001), and the need to place an invasive airway (OR 2.59; 95% CI 2.46 to 2.72; P<0.001) were associated with longer CPR duration. In those with ROSC, ventricular tachycardia or fibrillation (OR 0.89; 95% CI 0.85 to 0.93; P<0.001) and witnessed events (OR 0.87; 95% CI 0.82 to 0.91; P<0.001) were associated with shorter duration.
Conclusions
Age and sex were associated with attempted CPR duration in patients who do not experience ROSC after in‐hospital cardiac arrest but not in those who experience ROSC. Understanding the mechanism of these interactions may help explain variability in outcomes for in‐hospital cardiac arrest.