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Prolonged (>35 min) cardiopulmonary resuscitation (CPR) attempts in children after in-hospital cardiac arrest can result in a high rate of neurologically favourable survival to hospital discharge. This finding comes from an analysis of data in the AHA Get With The Guidelines–Resuscitation registry. In the mid 1990s, paediatric CPR beyond 20 min was considered futile, but these new data indicate that “providers should consider longer-duration CPR for some paediatric patients who suffer in-hospital cardiac arrests,” says Dr Renée Matos, the lead author on the study report.

The investigators analysed data on 3,419 children (mean age 4.9 ± 6.0 years) who experienced an in-hospital cardiac arrest in one of 328 US or Canadian sites between January 2000 and December 2009. Return of spontaneous circulation occurred in 63.7% of patients, but only 27.9% survived to hospital discharge, and 19.0% had a favourable neurological outcome.

Survival decreased linearly by 2.1% per min during the first 15 min of CPR. Survival continued to decrease with increasing duration of CPR (44% for 1–15 min, 18% for 16–35 min, 16% for >35 min). The researchers also categorized patients according to illness, and found that surgical cardiac patients had the best survival compared with general medical patients.

Similarly, the rate of favourable neurological outcome decreased by 1.2% per min during the first 15 min of CPR, and continued to fall thereafter (among survivors: 70% for 1–15 min, 69% for 16–35 min, 60% for >35 min). Again, compared with general medical patients, surgical cardiac patients had the highest rate of neurologically favourable outcome.

“This study reassures us that prolonged resuscitation attempts do not result in a substantial increase in survivors with severe neurological injury,” says Dr Jerry Nolan, chair of the Steering Committee of the UK National Cardiac Arrest Audit. However, “as in adults, the evidence remains insufficient to recommend a minimum duration for in-hospital resuscitation attempts in children”.