Should age influence duration of CPR for cardiac arrests in the hospital?

Intuition says yes. What does the data say?

This is a series of articles on the duration of CPR for in-hospital cardiac arrest. An index to all posts in the series can be found here:

How long should CPR be performed after cardiac arrest in the hospital?

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Introduction

Although cardiopulmonary resuscitation (CPR) is performed on more than 250,000 people in U.S. hospitals each year, physicians receive no formal guidance or training on how long it should be performed.

This allows for flexibility and also results in a wide variation in the length of CPR: one-quarter of unsuccessful resuscitations are stopped in less than 15 minutes, while an equal number go longer than 30 minutes. Half range between 15 and 30 minutes, with a median of about 21 minutes.

New CPR guidelines: What changed?

This series of posts reviews the data that can support clinicians in making the ultimate life-and-death decision: stopping CPR in the hospital.

Here we focus on the effects of age on outcomes after cardiac arrest in the hospital.

New Data To Support Clinical Intuition

The influence of age on in-hospital cardiac arrest survival has historically been largely a matter of clinician intuition. The recent publication of large tranches of observational data from hospitals participating in a national registry, however, permit a more quantitative examination of this important relationship.

The new data can help inform questions like:

• How much does a person’s age determine their outcome after in-hospital cardiac arrest?

• Is there a time point after which CPR should be considered futile, and does this vary by patient age?

• If it’s wrong to perform CPR past the point of futility, should clinicians consider age when deciding how long to perform CPR—that is, when to stop?

Here we will examine the impact of patient age on in-hospital cardiac arrest outcomes for both shockable and non-shockable rhythms.

In-Hospital Cardiac Arrest Outcomes By Age and Rhythm Type