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'Code Blue' efforts to re-start the heart can go a little longer, study finds

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Hospitals where staff try a little longer and a little harder to re-start a stopped heart might see better survival rates, new research finds.

They’re called “code blue,” “code alert,” “full code” and other dramatic names and without last-ditch resuscitation attempts, television hospital dramas would be nowhere. But common wisdom holds that in real life, drawn-out efforts to save someone whose heart has stopped are often a waste of time. But are they?

Maybe not, researchers report on Tuesday. They found that in hospitals where resuscitation teams try a little longer and a little harder, patients are more likely to survive. And they are not any more likely to be disabled or brain-damaged than patients who revive more quickly.

“Our findings suggest that prolonging resuscitation efforts by 10 or 15 minutes might improve outcomes,” said Dr. Zachary Goldberger of the University of Washington, who led the research published in the Lancet medical journal.

There aren’t any firm guidelines on how long to keep trying to revive someone whose heart has stopped. Skilled doctors, nurses or technicians can keep the blood pumping and supply oxygen to the brain and other organs while working to re-start a stopped heart. The American Heart Association has detailed pointers on which measurements show a patient has a better chance of living, and on which treatments to give, from simple cardiopulmonary resuscitation or CPR to defibrillation and drugs. 

But how long do you keep trying?

“There is this thought that it is futile, or that even if you get immediate survival, that in the long-term you are not doing these patients any favors,” said Dr. Brahmajee Nallamothu of the University of Michigan and the Ann Arbor VA Medical Center, who worked on the study.

Each patient is different, so the researchers looked at hospitals, comparing the average time spent trying to resuscitate patients and tracking how many patients survived until they were released. “How long do hospitals try for before they call the code?” Nallamothu said. 

They looked at the records of 64,000 patients from 435 U.S. hospitals who suffered cardiac arrest in hospitals between 2000 and 2008. They divided the hospitals into four groups -- those whose staff tried on average for 25 minutes to revive patients, those where the average time was 22 minutes, then 19 minutes and then 16 minutes.

It is clearly bad news for the heart to stop; only 15 percent of all the patients lived. And the hospitals clearly didn’t give up easily. Usually a patient revived quickly if at all. But looking at the hospital averages showed trying a little longer could pay off.

“Patients at hospitals where resuscitation attempts lasted the longest were significantly more likely to be successfully revived (achieve restoration of a pulse for at least 20 minutes) and survive to be discharged from hospital than those at hospitals where attempts were shortest,” Nallamothu’s team wrote.

“The whole resuscitation team, the code team is already there,” Nallamothu said in a telephone interview. “To try a bit longer -- I don’t think it is too much of a burden. It didn’t seem that those patients at the hospitals where attempts were longer were having a worse outcome, neurologically.”

There could be other factors at work, Nallamothu said. It could be the patients are sicker at some hospitals than others. Some hospitals could be treating patients who are older and less likely to survive. Some hospitals may have staff who are more skilled at reviving patients.

“My gut feeling is when I think about this situation, it is an incredibly difficult clinical situation,” Nallamothu said. “We don’t want to give hard and fast rules. This is a first step.”

Another caveat -- the findings apply to hospital resuscitation only, and not CPR or other rescue attempts outside a hospital. But two British doctors, Jerry Nolan of the Royal United Hospital NHS Trust in Bath and Jasmeet Soar of Southmead Hospital in Bristol said it’s clear that trying for longer doesn’t necessarily hurt.

“If the cause of cardiac arrest is potentially reversible, it might be worthwhile to try for a little longer,” they wrote in a commentary in the Lancet.

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