Termination of Resuscitation Efforts
A rather frequent question that I encounter during CPR, BLS & ACLS courses is, “When do we stop CPR?”. This is a tricky question to answer. There are many factors that play into it. Today, we’re going to touch on those factors.
First thing, everyone needs to understand that only 10% of people will survive a cardiac arrest. That means that most resuscitations are unsuccessful. There is not one specific set of rules that will fit every situation. The termination of CPR needs to be adjusted to each situation appropriately. There are many things to consider when thinking about terminating CPR, they can include:
- witnessed cardiac arrest?
- time passed before CPR was first attempted
- time passed before first defibrillation attempt
- initial presenting heart rhythm
- cause of arrest (trauma, cardiac, overdose, etc.)
Typically, if the patient is in persistent asystole for 10 minutes or more (in 3 or more leads), and three rounds of cardiac drugs (epi & vaso) have been given, termination of resuscitation can be considered. If your intubated patient has an ETCO2 reading of less than 10 mmHg during CPR after 20 minutes, the survival rate is virtually zero.
With all of the thoughts about when to stop CPR, we need to remember when we DO NOT stop CPR. These are times when a prolonged resuscitation attempt is advised.
- Patients who have been given thrombolytics
- Arrest from toxins
- Persistent V-fib until the reversible causes have been treated (the H’s & T’s).