Ayal Pierce, MD
Resident Physician
George Washington University Hospital
Washington, District of Columbia
Disclosure information not submitted.
John Organick-Lee, MD
Resident Physician
George Washington University Hospital, United States
Disclosure information not submitted.
Ivy Benjenk, RN, MPH, PhD
Research Coordinator
George Washington University Hospital, United States
Disclosure information not submitted.
Margarita Popova, MD
Resident Physician
George Washington University Hospital, United States
Disclosure information not submitted.
Jordan Feltes, MD
George Washington Unversity
Washington, District of Columbia
Disclosure information not submitted.
Christopher Payette, MD
Resident Physician
George Washington University Hospital, United States
Disclosure information not submitted.
Anahita Rahimi-Saber, MD
Resident Physician
George Washington University Hospital, United States
Disclosure information not submitted.
Patrick McCarville, MD
Resident Physician
George Washington University Hospital, United States
Disclosure information not submitted.
Brad Pradarelli, n/a
MS4
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
David Yamane, BS, MD
Assistant Professor of Emergency Medicine, Anesthesiology, and Critical Care Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Natalie Sullivan, MD
Fellow in Disaster/Operational Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Title: When is Long Enough? Attending Years Correlates with Shorter Code in Non-Shockable Cardiac Arrest
Introduction: While metrics indicating futility in out of hospital cardiac arrest (OHCA) exist, there is little evidence suggesting when it is reasonable to cease resuscitation efforts. Length of resuscitation in OHCA is likely influenced by age, CPR length prior to arrival, and presenting rhythm. Some studies suggest longer resuscitation attempts have a higher likelihood of ROSC and survival to hospital discharge, however longer futile resuscitation may be a waste of resources. We studied whether attending experience, measured by years out of post graduate training, had a significant correlation with lengths of codes in non-shockable OHCAs.
Methods: We performed a single-center prospective observational study of OHCAs. Resuscitation bays were continuously recorded and OHCAs were analyzed by two reviewers. Patients presenting in a shockable rhythm were excluded. Due to right skew of the code length, data was log-transformed to ensure normal distribution. A linear regression model was run to look at the relationship between code length and attending years of experience, controlling for patient age and EMS rhythm. Data were also analyzed separately for patients who achieved ROSC and those who expired in the Emergency Department.
Results: Between 2017 and 2019, a total of 74 OHCAs presenting in asystole or pulseless electrical activity (PEA) were captured. Mean age of the patient was 59.7 with 50 male and 24 female patients. Attending mean years out of training was 15.7 (median: 17, range: 1 to 34). Average code length was 15:24 (min:sec) with a range from 3:07 to 53:37. The regression model found that for each additional year of attending experience, code length decreased by 2% (Coef. -0.02, p=0.003). Attending years was not a significant predictor of code length for patients who obtained ROSC. For patients who died, each additional year of attending experience was associated with a 2.5% (Coef. -0.025, p=0.001) decreased code length.
Conclusions: For OHCAs presenting in PEA or asystole, attending experience is correlated with a decrease in code length. This association strengthens when ROSC is not achieved. Further studies are needed on when it is appropriate to cease resuscitation, possible creation of a standard attempted resuscitation length, and what factors go into physicians calling a code.