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Association between cardiopulmonary resuscitation duration and survival after out-of-hospital cardiac arrest according: a first nationwide study in France

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Abstract

Objective

Determining whether to pursue or terminate resuscitation efforts remains one of the biggest challenges of cardiopulmonary resuscitation (CPR). No ideal cut-off duration has been recommended and the association between CPR duration and survival is still unclear for out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the association between CPR duration and 30-day survival after OHCA with favorable neurological outcomes according to initial rhythm.

Methods

This was an observational, retrospective analysis of the French national multicentric registry on cardiac arrest, RéAC. The primary endpoint was neurologically intact 30-day survival according to initial rhythm.

Results

20,628 patients were included. For non-shockable rhythms, the dynamic probability of 30-day survival with a Cerebral Performance Category (CPC) of 1 or 2 was less than 1% after 25 min of CPR. CPR duration over 10 min was not associated with 30-day survival with CPC of 1 or 2 (adjusted OR: 1.67; CI 95% 0.95–2.94). For shockable rhythms, the dynamic probability of 30-day survival with a CPC score of 1 or 2, was less than 1% after 54 min of CPR. CPR duration of 21–25 min was still associated with 30-day survival and 30-day survival with a CPC of 1 or 2 (adjusted OR: 2.77; CI 95% 2.16–3.57 and adjusted OR: 1.82; CI 95% 1.06–3.13, respectively).

Conclusions

Survival decreased rapidly with increasing CPR duration, especially for non-shockable rhythms. Pursuing CPR after 25 min may be futile for patients presenting a non-shockable rhythm. On the other hand, shockable rhythms might benefit from prolonged CPR.

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Data availability

The datasets analysed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The French National Cardiac Arrest Registry (RéAC) was supported by the French Society of Emergency Medicine (SFMU), the Fédération Française de Cardiologie, the University of Lille and the Institute of Health Engineering of Lille. We thank all of the prehospital emergency medical service units involved in the French National Out-of-Hospital Cardiac Arrest Registry (RéAC).

Funding

This study received no specific funding.

Author information

Authors and Affiliations

  1. Emergency Department, University Hospital of Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France

    Deborah Jaeger & Tahar Chouihed

  2. INSERM U1116, University of Lorraine, 54500, Vandoeuvre-Les-Nancy, France

    Deborah Jaeger & Tahar Chouihed

  3. Univ. Lille, CHU Lille, ULR 2694—METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France

    Martin Lafrance, Valentine Canon & Hervé Hubert

  4. French National Out-of-Hospital Cardiac Arrest Registry Research Group (Registre Electronique des Arrêts Cardiaques—RéAC), 59000, Lille, France

    Martin Lafrance, Valentine Canon & Hervé Hubert

  5. Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA

    Deborah Jaeger, Marinos Kosmopoulos, Christopher Gaisendrees & Demetri Yannopoulos

  6. Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany

    Christopher Gaisendrees

  7. Department of Emergency Medicine, University Hospital of Grenoble Alps, SAMU 38, Grenoble, France

    Guillaume Debaty

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  1. Deborah Jaeger
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  2. Martin Lafrance
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  3. Valentine Canon
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  7. Demetri Yannopoulos
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Consortia

GR-RéAC

Contributions

All authors contributed to the study’s conception and design. Methodology: DJ, ML, VC, GD, HH, TC. Formal analysis and investigation: ML, VC, HH. Writing—original draft preparation: DJ, ML. Writing—review and editing: All authors. Supervision: GD, DY, HH, TC.

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Correspondence to Deborah Jaeger.

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Conflict of interest

Demetri Yannopoulos received grants from the Leona M and Harry B Helmsley Charitable Trust.

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Jaeger, D., Lafrance, M., Canon, V. et al. Association between cardiopulmonary resuscitation duration and survival after out-of-hospital cardiac arrest according: a first nationwide study in France. Intern Emerg Med 19, 547–556 (2024). https://doi.org/10.1007/s11739-023-03449-8

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