Fu Shan Xue and colleagues express concern that longer resuscitation efforts did not significantly improve neurological outcomes and could simply prolong "inevitable death" in the highest-risk patients. We worry that they misunderstand key aspects of our study.1 First, the assertion that, in order for longer resuscitation efforts to be effective, they would have to improve neurological outcomes in those with longer resuscitations is erroneous. Indeed, we found that hospitals with longer efforts had similar neurological outcomes but higher survival rates than those with shorter efforts, suggesting a greater absolute number of patients surviving with favourable neurological outcomes in hospitals with longer efforts. Second, although residual confounding might exist, our multivariable models included many factors, such as age and comorbid conditions, to account for the potential effects of early termination due to patients' illness.
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