Why is this Important?
  • It is a poor stewardship of resources to continue a resuscitation when the prognosis is clearly dismal.
  • Hospitals need to steward their resources to distribute equitable care between its patients
When is it Appropriate to Stop CPR on a Pulseless Patient?
  • Patient shows signs of irreversible death
    • Rigor mortis
    • Decapitation
    • Rotting/decaying
  • Patient has dismal prognosis (3 studies discuss this)
    • Implementation of the universal BLS termination of resuscitation rule in a rural EMS system
      • Non-EMS witnessed arrest
      • No return of spontaneous circulation prior to transport
      • Only non-shockable rhythms present
    • Early identification of patients with out-of-hospital cardiac arrest with no chance of survival and consideration for organ donation
      • Non-EM witnessed arrest
      • Non-shockable INITIAL rhythm
      • No ROSC despite 3 doses of epinepherine
  • Duration of pre-hospital CPR and favorable neurologic outcomes for pediatric out-of-hospital cardiac arrests. A nationwide, population based cohort study
    • Less than 1% chance of recovery after 46 minutes of resuscitation
Additional Reading
  • Jordan MR, O’keefe MF, Weiss D, Cubberley CW, Maclean CD, Wolfson DL. Implementation of the universal BLS termination of resuscitation rule in a rural EMS system. Resuscitation. 2017;118:75-81.
  • Jabre P, Bougouin W, Dumas F, et al. Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation. Ann Intern Med. 2016;165(11):770-778.
  • Goto Y, Funada A, Goto Y. Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study. Circulation. 2016;134(25):2046-2059.