The maximal duration of cardiopulmonary resuscitation (CPR) is unknown. We report a case of prolonged CPR. We have then reviewed all published cases with CPR duration equal to or more than 20 minutes. The objective was to determine the survival rate, the neurological outcome, and the characteristics of the survivors. Measurements and Main Results. The CPR data for 82 patients was reviewed. The median duration of CPR was 75 minutes. Patients mean age was 43 ± 21 years with no significant comorbidities. The main causes of the cardiac arrests were myocardial infarction (29%), hypothermia (21%), and pulmonary emboli (12%). 74% of the arrests were witnessed, with a mean latency to CPR of 2 ± 6 minutes and good quality chest compression provided in 96% of the cases. Adjunct therapy included extracorporeal membrane oxygenation (18%), thrombolysis (15.8%), and rewarming for hypothermia (19.5%). 83% were alive at 1 year, with full neurological recovery reported in 63 patients. Conclusion. Patients undergoing prolonged CPR can survive with good outcome. Young age, myocardial infarction, and potentially reversible causes of cardiac arrest such as hypothermia and pulmonary emboli predict a favorable result, especially when the arrest is witnessed and followed by prompt and good resuscitative efforts.

Obesity and body mass index (BMI) have received increasing attention by both health care professionals and media. Obesity is defi ned by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) as a BMI of 30 or above. A January 2012 press release from the CDC noted that in 2009-2010, the prevalence of obesity among adults in the United States was 35.7%. That translates to more than 78 million Americans being obese. In June 2013, the American Medical Association offi cially labeled obesity a disease, which may affect how insurers and the government pay for not only weight-loss drugs but also reimbursement for inpatient and outpatient services. This increasing attention to obesity places some increased focus on how obesity may impact other clinical conditions. This article addresses the factors that affect postoperative complications in high-risk overweight and obese patients and describes how to decrease the length of hospital stay in this population. Category: SpineLearning Objectives: After participating in this CME activity, the neurosurgeon should be better able to: 1. Identify the factors that can help minimize postoperative complications in high-risk patients. 2. Decrease the length of hospital stay for obese patients, which has become a critical element in today's health care environment.