In Cardiac Resuscitation Less is Not More
Ann Arbor―Primetime television medical dramas often depict doctors trying desperately to revive a patient in cardiac arrest, but surprisingly, in real life, there are no clear guidelines to help doctors determine how long to continue resuscitation efforts. Now, a new study conducted by a number of Robert Wood Johnson Foundation Clinical Scholars and program directors, and others, published online in The Lancet challenges the conventional wisdom that longer resuscitation efforts may be futile.
“One of the most challenging decisions facing clinicians who care for hospitalized patients is determining when to end resuscitation efforts during cardiac arrest,” said Zachary Goldberger, MD, MS, a 2010-2012 Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan, and the study’s lead author. “Our study offers additional insight on how long to continue efforts once resuscitative efforts have started.”
In the U.S., 200,000 hospitalized patients suffer cardiac arrest annually and only half survive. Of the half that survives, only 28 percent are ultimately discharged from the hospital.
Goldberger and colleagues analyzed 64,339 patients at 435 hospitals within the American Heart Association’s Get-With-The Guidelines®—Resuscitation registry, the largest sample of patients with in-hospital cardiac arrest available in the United States. While the duration of resuscitation attempts varied across hospitals, patients at hospitals who practiced the longest durations of resuscitation, on average, had a 12 percent higher overall survival rate compared with patients at hospitals with the shortest resuscitation attempts. Most surprisingly, however, those patients did not appear to suffer worse neurological outcomes. Fear of brain damage is one of the driving factors behind the conventional wisdom that “less is more” in resuscitation.
“While our study cannot define an exact duration of resuscitation for all hospitalized patients,” said Rodney A. Hayward, M.D, Director of the Michigan Robert Wood Johnson Foundation Clinical Scholars program and a co-author of the study, “It does suggest that if hospitals systematically increase their duration of resuscitation attempts, it may improve survival rates for a number of these patients.”
Hayward, known for his work in hospital policy, has also conducted research in physician decision-making.
“There’s no question that the decision on how long and when to end resuscitation efforts remains in the hands of physicians at the bedside, but our study helps shed some much needed light on these decisions” said Goldberger.
The study, “Duration of resuscitation efforts and survival after in-hospital cardiac arrest,” will be published online in The Lancet on Sept. 5.
The research findings presented here are those of the researchers and do not necessarily reflect the views of the Robert Wood Johnson Foundation.
For more than three decades, the Robert Wood Johnson Foundation Clinical Scholars program has fostered the development of physicians who are leading the transformation of health care in the United States through positions in academic medicine, public health and other leadership roles. Through the program, future leaders learn to conduct innovative research and work with communities, organizations, practitioners and policy-makers on issues important to the health and well-being of all Americans. This program is supported in part through collaboration with the U.S. Department of Veterans Affairs. For more information, visit http://rwjcsp.unc.edu.
Robert Wood Johnson Foundation Clinical Scholars and Study Authors
Zachary D. Goldberger, MD, MS, 2010-2012 Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan, lead author; Rodney A. Hayward, M.D, Director of the Michigan Robert Wood Johnson Foundation Clinical Scholars program, co-author; Harlan M. Krumholz, MD SM, Director of the Yale Robert Wood Johnson Foundation Clinical Scholars program, co-author
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About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter (www.rwjf.org/twitter) or Facebook (www.rwjf.org/facebook).