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

Figure 1

Flow diagram of retrospective study on cardiopulmonary resuscitation and return of spontaneous circulation in intensive care unit patients. CPR: Cardiopulmonary resuscitation; DNR: Do-not-resuscitate; ROSC: Return of spontaneous circulation.

Figure 2

Initial cardiac rhythm distribution among study participants. Pie chart showing the proportion of patients with pulseless electrical activity (48.6%), asystole (35.2%), and ventricular fibrillation/tachycardia (16.2%) as initial recorded rhythms. VF: Ventricular fibrillation; VT: Ventricular tachycardia; PEA: Pulseless electrical activity.

Figure 3

Duration of cardiopulmonary resuscitation distribution. Box-and-whisker plot displaying the median cardiopulmonary resuscitation duration of 15 minutes (interquartile range: 10-22 minutes). CPR: Cardiopulmonary resuscitation; MICU: Medical intensive care unit.

Figure 4

Probability of return of spontaneous circulation by cardiopulmonary resuscitation duration. Kaplan-Meier curve demonstrating the declining probability of return of spontaneous circulation achievement with increasing duration of cardiopulmonary resuscitation (log-rank P < 0.001).

Figure 5

Survival outcomes. CPR: Cardiopulmonary resuscitation; DNR: Do-not-resuscitate; ROSC: Return of spontaneous circulation.

Figure 6

Forest plot of mortality predictors. Graphical representation of multivariate Cox regression results showing hazard ratios of mortality predictors. CPR: Cardiopulmonary resuscitation; ROSC: Return of spontaneous circulation.