To evaluate the effect of CPR duration on clinical outcomes in children, the authors of a recent study analyzed data from the American Heart Association's Get with the Guidelines-Resuscitation registry. The researchers analyzed data from 2000 to 2009 on in-hospital cardiac arrests among patients younger than 18 years at 328 U.S. and Canadian hospitals.

A total of 3,419 cardiac arrests occurred; the median age of patients was five years. Of these, 64% experienced a return to spontaneous circulation for more than 20 minutes, 40% were alive 24 hours after the arrest, and 28% (954 patients) survived to discharge. Neurologic outcome was measured using the pediatric cerebral performance category scales, with a favorable outcome defined as a discharge score between 1 (normal) and 3 (moderate disability) or a discharge score no lower than the score obtained at admission. Overall, 68% of the 954 patients who survived had a favorable neurologic outcome.

A higher percentage of the 954 survivors received CPR for between 15 and 35 minutes (36%) than for longer than 35 minutes (17%). In fact, the survival rate decreased steadily as CPR duration increased. Similarly, the likelihood of a favorable neurologic outcome decreased with increasing CPR time; however, 65% of the survivors who received CPR for between 15 and 35 minutes and 60% who had CPR for longer than 35 minutes had favorable neurologic outcomes.

By stratifying patients into predefined illness categories, the authors found that surgical cardiac patients were most likely to survive to discharge and have a favorable neurologic outcome, and trauma patients were least likely to survive and had the poorest neurologic outcomes.

The authors conclude that despite the inverse relationship between the duration of CPR and survival to hospital discharge, as well as neurologic outcome, the surprising success of long-duration CPR-even in a small number of patients-indicates that clinicians shouldn't abandon CPR too early.

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