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Michel Boucher Thu, 02 May 2002 05:42:05 -0700

Title: AEM -- Abstracts: Niemann et al. 9 (5): 459-a

Bonjour,

Plusieurs articles intéressants dans ce numéro de Academic Emergency Medicine. Celui-ci traite de l'arrêt des manoeuvres de réa après 30 minutes et de conséquences de ne pas respecter cette recommandation.

Bonne lecture,

Michel Boucher

CPR

The ACLS Thirty-minute Stop Guideline

Consequences of Noncompliance

James T Niemann, Samuel J Stratton and Nisha Chandra-Strobos

Harbor-UCLA Medical Center: Torrance, CA, Johns Hopkins Medical Institutions: Baltimore, MD

ABSTRACT

Current American Heart Association (AHA) guidelines state thatresuscitative efforts should be discontinued if there is norestoration of spontaneous circulation (ROSC) at any time during30 min of cumulative Advanced Cardiac Life Support (ACLS).Few studies have evaluated the outcome of patients attainingROSC after 30 min nor the societal or financial impact of continuingACLS beyond 30 min. Objective: To evaluate survival to hospitaldischarge (SHD), neurologic outcome, and resource utilizationof patients resuscitated after 30 min. Methods: In this observational,retrospective cohort study, the out-of-hospital and hospitalmedical records of all patients treated for out-of-hospitalnontraumatic cardiac arrest at two large urban hospitals werereviewed. At one site, the study period was 22 mo; at the other,12 mo. Patients were excluded if <18 yr or if out-of-hospitalACLS was not initiated. Study variables included time to ROSC(<30 or >30 min), survival to hospital admission (SHA),and SHD rates, Glasgow Coma Scale (GCS) at time of discharge,intensive care unit (ICU) bed utilization, and hospital charges(year 2000 dollars). Results: 245 patients met inclusion criteria.Of these, 64 (19%) survived to hospital admission and 16 (6.6%)to hospital discharge. Outcomes categorized by time to ROSCare summarized in the table:

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The sole survivor in the >30 min group was vegetative. Thus,the charges for one survivor in the group were >$500,000.For the <30 min group, charges per survivor were approximately$50,000. Four patients in the <30 min group were dischargedwith a GCS

14. The charges for an "intact" neurologic survivorwere therefore approximately $190,000. Conclusion: Noncompliancewith the 30-minue guideline is a futile endeavor, results inno meaningful survival, wastes valuable resources, and is costly.