Title: Duration of Code and Survival following Cardiac Arrest: A Single Center Retrospective Cohort Study
Author(s): Kwabena Owusu-Ansah, MD; Stanley Ifeanyi Ozogbo, MD; Ethan Macabobby, BS; Timothy J. Barreiro, DO; David Gemmel, PhD
Email: KOwusuAnsah@mercy.com
Rationale: In 2022, among 560,000 cardiac arrests, only 140,000 survived, accentuating the critical need to evaluate current cardiac arrest treatment and response strategies. The purpose of this study was to describe the association between duration of code and survivability with favorable neurologic status.
Methods: A single center retrospective cohort study of outcomes of codes (n=282) between January 2022 and July 2023 was undertaken. Predictive variables included out of hospital (OHCA) and witnessed arrests, time to initiation of CPR, cardiac rhythm, return of spontaneous circulation (ROSC), age, sex, race, Charlson Index, brain anoxia and modified Rankin score (mRS). Survivorship was examined by whether time of death was called immediately post code, by survival to discharge, and by survival to discharge with mRS < 4. Additionally, code re-runs were abstracted from the electronic medical record.
RESULTS: In this cohort, 55% of patients were male; average age was 66+17 years; 75% of patients were white; and mean Charlson co-morbidity index 10-year survival was 51+38%. Seventy-one percent of codes were ED initiated, 13% were in hospital codes on the floors/units; and the remaining 16% were MICU or SICU events. Out of hospital arrests represented 59.2% of the series. Non-shockable rhythms (PEA and asystole) comprised 72.3% of patients. 9.5% of arrests were witnessed; in these patients, response was immediate in 84.2% (n=165/196). Average code duration was 21+16 minutes. ROSC was noted in 47.9% of patients. Almost half of patients (n=134) deceased immediately post code. Survival to discharge was 14.9%. Anoxic brain injury was noted in 19.1% of survivors; likewise, mRS > 4was 86.4% in the cohort. Among patients who survived initial code status (n=148), 17.6% had codes re-run. There was no association between duration of code and immediate survival, survival to discharge, or neurological outcomes. In multivariate logistic regression analysis, duration of code was not associated with outcomes; only OHCA and ROSC predicted survival. In patients surviving to discharge (n=42), mRS < 4 was 73.8%; among those with codes rerun (n=26), mRS < 4 was 11.5%.
CONCLUSIONS: Duration of code was not associated with survival or neurological outcomes in this cohort. The literature has defined prolonged codes as greater than 25, 30, or even 40 minutes. Mean code duration in this series is similar to Bradley (2017) for prolonged code, ~ 25 minutes. Institutional factors and community patient demographics may help explain the lack of an association between duration of code and outcome (Reynolds,2013). This study adds to the literature by describing neurological sequalae post code, as well as the rate of re-running codes. AHA Get With the Guidelines registry participation for resuscitation or independent data audit may allow for benchmarking and assessment of interventions.
