ArticlePloS one2025
When to stop: Understanding the landscape of extreme-duration cardiopulmonary resuscitation practices among pediatricians in Sudan.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPediatric cardiopulmonary resuscitation (CPR) is a life-saving intervention, but its effectiveness in extreme durations remains debated. This study aimed to explore the frequency and decision-making regarding prolonged CPR (PCPR) practices in hospitalized Sudanese children.
methodsA web-based cross-sectional survey was conducted among pediatricians and pediatric trainees in Sudan. The survey investigated their experience with prolonged, ultra-prolonged, and extreme-duration CPR and factors influencing termination decisions.
resultsNinety-six Sudanese pediatricians and trainees responded to the survey, reporting varied experiences with prolonged CPR durations: over half (51%) and 81% of respondents reported encountering extreme-duration (> 12 hours) and ultra-prolonged (> 2 hours) CPR at least once, respectively. Around 5% and 1% reported to have encountered CPR durations of 48-72 hours and more than 72 hours, respectively, while 18% reported a 12-14-hour as their record high CPR duration. Four participants reported encountering extreme-duration (> 12 hours) CPR more than 15 times. Respondents most frequently (41%) cited the absence of a pulse and heartbeat as the primary factor for terminating CPR. A vast majority acknowledged ethical considerations (84%) and a lack of clear protocols (83%) as a barrier to terminating PCPR. Thematic analysis of an open question revealed a critical need for a standardized protocol addressing PCPR, enhanced CPR training, and better post-resuscitation support.
conclusionsThis study revealed a relatively high frequency of extended-duration CPR in Sudanese pediatric settings. Termination decisions focused on cardiac activity becoming clinically undetectable rather than brain death signs or specific cutoff CPR durations. The absence of a clear protocol on when to terminate CPR seems to contribute the most to this phenomenon. Further research on patient outcomes after prolonged CPR in this context is warranted.
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