Refractory cardiac arrest Claudio Sandroni Dept. of Anaesthesiology and Intensive Care Catholic University School of Medicine –Rome –Italy IRC Scientific Committee Conflicts of interest None Cardiac arrest: how long should we treat? • When initial resuscitation efforts are unsuccessful, the team should decide if and how CPR should be continued • ERC Guidelines (2015) discontinuation criteria: – Ongoing advanced life support – Absence of reversible causes – Asystole > 20 min. CPR duration and neurological outcome n = 1014 Reynolds J et al. Circulation 2013; 128:2488-2494 However… n = 64,339 IHCAs 25% achieved ROSC >20 min 12% achieved ROSC >30 min. Goldberger ZD et al Lancet 2012; 380:1473–1481 Neurological outcome and CPR duration 100 90 80 70 60 <15 min 50 15-30 min 40 >30 min 30 20 10 0 Favourable neurological outcome, % Goldberger ZD et al Lancet 2012; 380:1473–1481 Factors for survival in refractory CA • Secondary analysis of the ROC-PRIMED trial – 11,368 OHCAs – 905 survived w/mRS ≤3 • Primary exposure: duration of resuscitation • Association tested with logistic regression models Reynolds J et al. Circulation. 2016;134:2084-2094 Results • Duration of resuscitation was independently associated with survival with good neurological outcome • The longest observed CPR duration with good neurological outcome was 47 minutes Reynolds J et al. Circulation. 2016;134:2084-2094 Reynolds J et al. Circulation. 2016;134:2084-2094 Reynolds J et al. Circulation. 2016;134:2084-2094