Cardiopulmonary resuscitation duration and patient survival in a South Indian intensive care unit

Abstract

BACKGROUND

Return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR) is a critical determinant of survival in patients experiencing cardiac arrest. This study aimed to investigate the relationship between the duration of CPR, the achievement of ROSC, and both short-term [intensive care unit (ICU) and in-hospital] and long-term survival outcomes in patients admitted to the medical intensive care unit (MICU) of Dr. Moopen’s Medical College Hospital, Wayanad, Kerala, India.

AIM

To assess how cardiopulmonary resuscitation duration impacts short-term and long-term survival in cardiac arrest patients in intensive care.

METHODS

A retrospective observational cohort study was conducted on adult patients who received CPR in the MICU between March 2023 and March 2024. Data were extracted from electronic medical records, including demographics, duration of CPR, ROSC achievement, and survival outcomes. Short-term survival was defined as survival to ICU discharge and in-hospital mortality, while long-term survival was assessed at six months post-arrest. Statistical analysis was performed using SPSS software, with Kaplan-Meier survival analysis and Cox regression used to identify predictors of mortality.

RESULTS

A total of 142 patients were included in the study. The median duration of CPR was 15 minutes. ROSC was achieved in 68 patients (47.9%). A significant association was observed between the duration of CPR and ROSC achievement (P < 0.001). Patients who achieved ROSC early had significantly higher rates of short-term and long-term survival compared to those who did not (P < 0.001). Each additional minute of CPR was associated with a 7% decrease in the odds of achieving ROSC. Longer CPR duration (HR: 1.05, 95%CI: 1.02-1.08), absence of ROSC (HR: 4.87, 95%CI: 2.31-10.28), older age (HR: 1.03, 95%CI: 1.01-1.06) and unwitnessed arrest (HR: 1.89, 95%CI: 1.05-3.41) were independent predictors of mortality.

CONCLUSION

Timely, effective cardiopulmonary resuscitation improves survival in intensive care. Duration significantly predicts return of circulation and outcomes. Further research should explore factors affecting resuscitation length and optimize treatment strategies.

Keywords: Cardiopulmonary resuscitation; Return of spontaneous circulation; Survival; Intensive care unit; Cardiac arrest; Critical care; India

Core Tip: This study investigated the association between cardiopulmonary resuscitation (CPR) duration and survival outcomes in critically ill patients admitted to a medical intensive care unit in South India. Longer CPR duration was significantly associated with lower rates of return of spontaneous circulation (ROSC) and decreased short-term and long-term survival. Each additional minute of CPR decreased the odds of achieving ROSC. These findings underscore the importance of timely and effective CPR in improving outcomes for critically ill patients.