CRISMA Center, Pittsburgh, PA, USA.
Circulation. 2013 Jan 29;127(4):442-51. doi: 10.1161/CIRCULATIONAHA.112.125625. Epub 2013 Jan 22.
Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric in-hospital cardiac arrests. This concept has recently been questioned, although the effect of CPR duration on outcomes has not recently been described. Our objective was to determine the relationship between CPR duration and outcomes after pediatric in-hospital cardiac arrests.
We examined the effect of CPR duration for pediatric in-hospital cardiac arrests from the Get With The Guidelines-Resuscitation prospective, multicenter registry of in-hospital cardiac arrests. We included 3419 children from 328 U.S. and Canadian Get With The Guidelines-Resuscitation sites with an in-hospital cardiac arrest between January 2000 and December 2009. Patients were stratified into 5 patient illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma. Survival to discharge was 27.9%, but only 19.0% of all cardiac arrest patients had favorable neurological outcomes. Between 1 and 15 minutes of CPR, survival decreased linearly by 2.1% per minute, and rates of favorable neurological outcome decreased by 1.2% per minute. Adjusted probability of survival was 41% for CPR duration of 1 to 15 minutes and 12% for >35 minutes. Among survivors, favorable neurological outcome occurred in 70% undergoing <15 minutes of CPR and 60% undergoing CPR >35 minutes. Compared with general medical patients, surgical cardiac patients had the highest adjusted odds ratios for survival and favorable neurological outcomes, 2.5 (95% confidence interval, 1.8-3.4) and 2.7 (95% confidence interval, 2.0-3.9), respectively.
CPR duration was independently associated with survival to hospital discharge and neurological outcome. Among survivors, neurological outcome was favorable for the majority of patients. Performing CPR for >20 minutes is not futile in some patient illness categories.
儿科心肺复苏（CPR）超过 20 分钟后被认为是无效的，因为儿科院内心脏骤停。最近，这一概念受到了质疑，尽管 CPR 持续时间对结果的影响尚未得到描述。我们的目的是确定儿科院内心脏骤停后 CPR 持续时间与结果之间的关系。
我们从 Get With The Guidelines-Resuscitation 前瞻性、多中心院内心脏骤停注册研究中检查了儿科院内心脏骤停中 CPR 持续时间的影响。我们纳入了 2000 年 1 月至 2009 年 12 月期间来自美国和加拿大 328 个 Get With The Guidelines-Resuscitation 地点的 3419 名儿科患者。患者分为 5 种患者疾病类别：心脏手术、心脏内科、一般内科、普通外科和创伤。出院存活率为 27.9%，但只有 19.0%的所有心脏骤停患者有良好的神经学结果。在 1 至 15 分钟的 CPR 之间，存活率以每分钟 2.1%的线性速度下降，而良好的神经学结果的发生率以每分钟 1.2%的速度下降。CPR 持续时间为 1 至 15 分钟的调整后存活概率为 41%，CPR 持续时间>35 分钟的为 12%。在幸存者中，接受<15 分钟 CPR 的患者中有 70%发生了良好的神经学结果，而接受 CPR>35 分钟的患者中有 60%发生了良好的神经学结果。与一般内科患者相比，心脏手术患者的存活和良好神经学结果的调整后优势比最高，分别为 2.5（95%置信区间，1.8-3.4）和 2.7（95%置信区间，2.0-3.9）。
CPR 持续时间与出院时的存活率和神经学结果独立相关。在幸存者中，大多数患者的神经学结果良好。在某些患者疾病类别中，CPR 持续时间>20 分钟并非无效。
